Individual provider Active NPI

Paulina Lynn Vantimmeren, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1659157741
Registry record updated Mar 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2060 E Paris Ave SE Ste 100
Grand Rapids, MI 49546-6113
Phone
(616) 460-4548
NPI assigned
Sep 5, 2023
Last updated
Mar 23, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

2060 E Paris Ave SE Ste 100
Grand Rapids, MI 49546-6113

Mailing address

942 Benjamin Ave SE
Grand Rapids, MI 49506-3221
Phone (616) 460-4548

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230925002869 MI Practitioner - Physician Assistant 6103270103 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Midwest Institute of Health PCGroup PAC ID 2466516091, 13 clinicians
Metropolitan HospitalGroup PAC ID 5597651836, 421 clinicians

Practice addresses (Care Compare)

2060 E Paris Ave SE
Suite 100
Grand Rapids, MI 49546-6113
Phone (616) 956-6100

5900 Byron Ctr Ave
Wyoming, MI 49519-9606

5900 Byron Ctr Ave SW
Wyoming, MI 49519-9606
Phone (616) 252-3243

5900 Byron Ctr Swave
Wyoming, MI 49519-9606
Phone (616) 252-7200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group Physician Assistant CurrentSince May 9, 2024 Accepting new patients
Advantage Health/Saint Mary's Medical Group CurrentSince May 9, 2024 Accepting new patients
Metropolitan Hospital CurrentSince Jan 1, 2024 Accepting new patients
Gastroenterology Consultants PLC PastSince Sep 1, 2023 Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

5900 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 252-3243

Interoperability endpoints

  • Direct secure messaging: ppodsiadlik3047732@direct.trinity-health.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774224000000",
    "number": "1659157741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "942 BENJAMIN AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495063221",
            "telephone_number": "616-460-4548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 E PARIS AVE SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466113",
            "telephone_number": "616-460-4548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANTIMMEREN",
        "first_name": "PAULINA",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-05",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.