Todd Boonstra, PA
Individual provider Active NPI Physician Assistant · Zeeland, MI
NPI 1679587661 · NPPES record last updated Sep 10, 2021
Key facts
- NPI
- 1679587661
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601003342 (MI)
- Practice address
- 8300 Westpark Way
Zeeland, MI 49464-7901 - Phone
- (616) 748-5778
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Holland Community Hospital
Practice addresses (Care Compare)
577 Michigan Ave
Holland, MI 49423-4911
8300 Westpark Way
Zeeland, MI 49464-7901
Hospital & facility affiliations
- Holland Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110224000082 | MI | Practitioner - Physician Assistant | 8729059381 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA759 | KY | MD | Physician Assistant |
| 5601003342 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bronson South Haven Hospital | Current |
Accepting new patients | |
| Holland Community Hospital | Current |
Accepting new patients | |
| Bronson South Haven Hospital | Current |
Accepting new patients | |
| Holland Community Hospital | Physician Assistant | Current |
Accepting new patients |
| Holland Community Hospital | Past | Accepting new patients | |
| Community Memorial Hospital | Past | Accepting new patients | |
| JMHC Inc | Past | Accepting new patients | |
| Community Memorial Hospital | Physician Assistant | Past | Accepting new patients |
Locations
100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242
577 Michigan Ave
Ste 101
Holland, MI 49423
Phone (616) 393-2190
950 S Bailey Ave
South Haven, MI 49090
Phone (269) 639-2796
8300 Westpark Way
Zeeland, MI 49464
Phone (616) 748-5760
Interoperability endpoints
- todd.boonstra@holland.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA759 | KY | |
| Physician Assistant | 363A00000X | 5601003342 | MI | Yes |
Addresses
Primary practice location
8300 Westpark Way
Zeeland, MI 49464-7901
Mailing address
8300 Westpark Way
Zeeland, MI 49464-7901
Phone (616) 748-5778
Other providers in Zeeland, MI
- Matthew Jay Boeve
- Bokma Chiropractic PLLC
- Abigail Bokma
- Simon Bokma
- Amber Joy Bolhuis
- Allison Booth
- Elizabeth Sayre Bouma
- Nichole B Bowker
- Laura Anne Bowling
- Bpi Pharmacy Inc
All providers in Zeeland, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.