Individual provider Active NPI

Amra Bristina, NP-C

  • Family Nurse Practitioner
  • Wyoming, MI
National Provider Identifier
1699256784
Registry record updated Oct 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704296387 Issued in MI
Practice address
2215 44TH St SW
Wyoming, MI 49519-6439
Phone
(616) 252-8300
Fax
(616) 252-8460
NPI assigned
Aug 27, 2018
Last updated
Oct 9, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2018

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 4704296387 MI Primary

Addresses

Primary practice location

2215 44TH St SW
Wyoming, MI 49519-6439

Mailing address

5900 Byron Center Ave SW
Medical Administration
Wyoming, MI 49519-9606
Phone (616) 252-8300

Other identifiers 1

IdentifierTypeStateIssuer
1699256784MedicaidMI

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
I20190529001223 MI Practitioner - Nurse Practitioner 9133462534 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
Group practices
Metropolitan HospitalGroup PAC ID 5597651836, 421 clinicians

Practice addresses (Care Compare)

2215 44TH St SW
Metro Health Southwest
Wyoming, MI 49519-6439
Phone (616) 252-8300

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Hospital CurrentSince May 1, 2019 Accepting new patients
Metropolitan Hospital Past Accepting new patients
Metropolitan Hospital PastSince May 1, 2019 Accepting new patients

Locations

4055 Cascade Rd SE
Ste 100
Grand Rapids, MI 49546
Phone (616) 252-4010

2215 44th St SW
Wyoming, MI 49519
Phone (616) 252-8300

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

Interoperability endpoints

  • Direct secure messaging: abristina60100@direct.metrohealth.net

Organizations & group practices 3

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 1

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": "1535328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1699256784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 BYRON CENTER AVE SW",
            "address_2": "MEDICAL ADMINISTRATION",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199606",
            "telephone_number": "616-252-8300",
            "fax_number": "616-252-8460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 44TH ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495196439",
            "telephone_number": "616-252-8300",
            "fax_number": "616-252-8460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISTINA",
        "first_name": "AMRA",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-27",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704296387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699256784",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

Verify at the official NPI Registry.