Individual provider Active NPI

Jillian Mulder, FNP

  • Family Nurse Practitioner
  • Holland, MI
National Provider Identifier
1750157525
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704306685 Issued in MI
Practice address
577 Michigan Ave Ste 101
Holland, MI 49423-4911
Phone
(616) 393-2190
NPI assigned
Dec 1, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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 4704306685 MI Primary

Addresses

Primary practice location

577 Michigan Ave Ste 101
Holland, MI 49423-4911

Mailing address

1598 S Shore Dr
Holland, MI 49423-4416

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
I20240828002718 MI Practitioner - Nurse Practitioner 9830638329 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holland Community HospitalGroup PAC ID 0446157291, 174 clinicians

Practice addresses (Care Compare)

577 Michigan Ave
Suite 101
Holland, MI 49423-4911
Phone (616) 393-2190

Hospital & facility affiliations

  • Holland Hospital Hospital, Holland, MI, CCN 230072

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704306685MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Holland Community Hospital CurrentSince Aug 12, 2024 Accepting new patients
Holland Community Hospital CurrentSince Aug 12, 2024 Accepting new patients
Holland Community Hospital Current Accepting new patients

Locations

577 Michigan Ave
Ste 101
Holland, MI 49423
Phone (616) 393-2190

577 Michigan Ave
Holland, MI 49423
Phone (616) 393-2190

8300 Westpark Way
Zeeland, MI 49464
Phone (616) 748-5760

Interoperability endpoints

  • Direct secure messaging: jillian.mulder@holland.eclinicaldirectplus.com

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 and National Provider Directory roles.

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": "1701388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1750157525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1598 S SHORE DR",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "577 MICHIGAN AVE STE 101",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234911",
            "telephone_number": "616-393-2190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULDER",
        "first_name": "JILLIAN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-01",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704306685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

Verify at the official NPI Registry.