Individual provider Active NPI

Joel R Wolfe, M.D.

  • Orthopaedic Surgery Physician
  • Holland, MI
National Provider Identifier
1710987870
Registry record updated Mar 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
JW051928 Issued in MI
Practice address
370 120TH Ave
Holland, MI 49424-2196
Phone
(616) 396-5855
Fax
(616) 396-5720
NPI assigned
Jul 29, 2005
Last updated
Mar 5, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X JW051928 MI Primary

Addresses

Primary practice location

370 120TH Ave
Holland, MI 49424-2196

Mailing address

370 120TH Ave
Holland, MI 49424-2196
Phone (616) 396-5855

Other identifiers 5

IdentifierTypeStateIssuer
P70442OtherMIBLUE CARE NETWORK
2977390MedicaidMI
0888470001OtherMIMEDICARE DME PTAN
JW051928OtherMISTATE LICENSE
4361552OtherMIAETNA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100108000784 MI Practitioner - Orthopedic Surgery 2860477791 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
JW051928MIMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shoreline Orthopaedic & Sports Medicine Clinic,PLC Orthopaedic Surgery CurrentSince Oct 1, 1990 Accepting new patients
Shoreline Orthopaedic & Sports Medicine Clinic P L C Orthopaedic Surgery CurrentSince Oct 1, 1990 Accepting new patients

Locations

370 N 120th Ave
Holland, MI 49424
Phone (616) 396-5855

370 N 120th Ave
Ste 20
Holland, MI 49424
Phone (616) 396-5855

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.

NPI Registry JSON

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393977600000",
    "number": "1710987870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 120TH AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242196",
            "telephone_number": "616-396-5855",
            "fax_number": "616-396-5720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 120TH AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242196",
            "telephone_number": "616-396-5855",
            "fax_number": "616-396-5720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLFE",
        "first_name": "JOEL",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2014-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "JW051928",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "P70442",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2977390",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME PTAN",
            "identifier": "0888470001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "JW051928",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4361552",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

Verify at the official NPI Registry.