NPIMap

Individual provider Active NPI

Jennifer Anne Hultman, MD

  • Pediatrics Physician
  • Grand Rapids, MI
National Provider Identifier
1750597027
Registry record updated Nov 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301081919 Issued in MI
Practice address
21 Michigan St NE
Suite 525
Grand Rapids, MI 49503-2528
Phone
(616) 391-3776
NPI assigned
May 15, 2007
Last updated
Nov 20, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301081919 MI
Pediatrics Physician 208000000X 4301081919 MI Primary

Addresses

Primary practice location

21 Michigan St NE
Suite 525
Grand Rapids, MI 49503-2528

Mailing address

2721 Rum Creek Dr SE
Kentwood, MI 49508-5279
Phone (616) 971-8000

Other names 1

  • Dr. Jennifer Anne Clift Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071109000533 MI Practitioner - Pediatric MedicinePractitioner - Internal Medicine 8527156439 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Internal Medicine
Education
Michigan State University College of Human Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2700 Baker St
FL 3
Muskegon, MI 49444-2157
Phone (231) 737-1335

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301081919MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hackley Community Care Center Inc Current Accepting new patients
Hackley Community Care Center, Inc CurrentSince Nov 1, 2007 Accepting new patients
Hackley Community Care Center Inc CurrentSince Nov 1, 2007 Accepting new patients

Locations

1550 Clinton St
Muskegon, MI 49442
Phone (231) 733-6910

2700 Baker St
Fl 3
Muskegon Heights, MI 49444
Phone (231) 733-6607

Interoperability endpoints

  • Direct secure messaging: jenniferhultman@hccc.allscriptsdirect.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 4

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": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258675200000",
    "number": "1750597027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2721 RUM CREEK DR SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085279",
            "telephone_number": "616-971-8000",
            "fax_number": "616-971-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 MICHIGAN ST NE",
            "address_2": "SUITE 525",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032528",
            "telephone_number": "616-391-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HULTMAN",
        "first_name": "JENNIFER",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2009-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301081919",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301081919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "CLIFT",
            "middle_name": "ANNE",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.