Kevin J Wiersum, PAC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

5601004099 Issued in MI

Practice address

1111 Leffingwell Ave NE
Ste 100
Grand Rapids, MI 49525-6406

Phone

(616) 459-7101

NPI assigned

Oct 4, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopaedic Associates of Grand Rapids PCGroup PAC ID 9537136403, 86 clinicians

Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians

Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
• Corewell Health Big Rapids Hospital Hospital, Big Rapids, MI, CCN 230093
• Corewell Health Pennock Hospital Hospital, Hastings, MI, CCN 231339

Merit-based Incentive Payment System (MIPS)

Final score

78.51 of 100Reported as group

Quality

49.04

Promoting interoperability

96

Improvement activities

40

Cost

82.67

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kevin.wiersum.p1@direct.oam.nextgenshare.com

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

• Orthopaedic Associates of Grand Rapids, PC

  • Orthopaedic Surgery Physician
  • Grand Rapids, MI
  • NPI 1023021300
  Medicare reassignment Care Compare group NPD
• Center for Physical Rehabilitation and Therapy LP

  • Physical Therapy Clinic/Center
  • Grand Rapids, MI
  • NPI 1902288863
  Care Compare group
• Orthopaedic Associates of Grand Rapids PC

  • Durable Medical Equipment & Medical Supplies
  • Grand Rapids, MI
  • NPI 1740532035
  NPD

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

• Mecosta County Medical Center

  • General Acute Care Hospital
  • Big Rapids, MI
  • NPI 1316945991
  Care Compare affiliation
• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Spectrum Health Hospitals

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379462400000",
    "number": "1699762765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 LEFFINGWELL AVE NE",
            "address_2": "STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495256406",
            "telephone_number": "616-459-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 LEFFINGWELL AVE NE",
            "address_2": "STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495256406",
            "telephone_number": "616-459-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIERSUM",
        "first_name": "KEVIN",
        "middle_name": "J",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2013-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601004099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Wiersma
• Lisa Wiersma
• Rebecca L Wiersma, LMSW
• Shannon Lorelle Wiersma, NP
• Debbie Kay Wiersum, LMSW
• Alexandra Wierzbicki
• Elizabeth Wiessner
• Valerie Wieten
• Brooke Elizabeth Wietharn, MD
• Kaitlin Wiewiora, DO

• Surgical Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Surgical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.