Individual provider Active NPI

John Kenneth Dekock, NP-C

  • Nurse Practitioner
  • Wyoming, MI
National Provider Identifier
1740740190
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704302037 Issued in MI
Practice address
5838 Metro Way SW
Wyoming, MI 49519-9619
Phone
(616) 249-5300
NPI assigned
Mar 21, 2019
Last updated
Mar 26, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704302037 MI Primary

Addresses

Primary practice location

5838 Metro Way SW
Wyoming, MI 49519-9619

Mailing address

5838 Metro Way SW
Wyoming, MI 49519-9619

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
I20220203000338 MI Order and Referring Only - Nurse Practitioner 6800289414

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704302037MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Battle Creek Vamc CurrentSince Mar 31, 2024 Accepting new patients

Locations

5838 Metro Way SW
Wyoming, MI 49519
Phone (616) 249-5300

Organizations & group practices 1

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": "1553126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1740740190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5838 METRO WAY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5838 METRO WAY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199619",
            "telephone_number": "616-249-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEKOCK",
        "first_name": "JOHN",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-21",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704302037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

Verify at the official NPI Registry.