Individual provider Active NPI

Michele Marie Mentink, NP

  • Family Nurse Practitioner
  • Jackson, MI
National Provider Identifier
1679057517
Registry record updated Dec 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704274359 Issued in MI
Practice address
400 Hinckley Blvd Ste 100
Jackson, MI 49203-6152
Phone
(517) 205-8991
NPI assigned
Sep 17, 2018
Last updated
Dec 17, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704274359 MI Primary

Addresses

Primary practice location

400 Hinckley Blvd Ste 100
Jackson, MI 49203-6152

Mailing address

14174 Elm Row Rd
Albion, MI 49224-9611
Phone (517) 206-0067

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmentink453205@direct.hfhs.org

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
I20181213000881 MI Practitioner - Nurse Practitioner 7113262569 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

400 Hinckley Blvd
Suite 100
Jackson, MI 49203-6152
Phone (517) 205-8991

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704274359MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
W.a. Foote Memorial Hospital CurrentSince Jan 7, 2019 Accepting new patients
W.a. Foote Memorial Hospital, Inc Nurse Practitioner CurrentSince Jan 7, 2019 Accepting new patients

Locations

27931 C Dr N
Albion, MI 49224
Phone (517) 629-8311

400 Hinckley Blvd
Ste 100
Jackson, MI 49203
Phone (517) 205-8991

813 W Michigan Ave
Jackson, MI 49202
Phone (517) 205-1000

7845 Spring Arbor Rd
Spring Arbor, MI 49283
Phone (517) 205-2580

Organizations & group practices 2

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 2

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": "1537142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608163200000",
    "number": "1679057517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14174 ELM ROW RD",
            "city": "ALBION",
            "state": "MI",
            "postal_code": "492249611",
            "telephone_number": "517-206-0067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HINCKLEY BLVD STE 100",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492036152",
            "telephone_number": "517-205-8991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENTINK",
        "first_name": "MICHELE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-17",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704274359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmentink453205@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "400 Hinckley Blvd Ste 100",
            "city": "Jackson",
            "state": "MI",
            "country_code": "US",
            "postal_code": "492036152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.