Individual provider Active NPI

Jill Wiersma

  • Physical Therapist
  • Grand Rapids, MI
National Provider Identifier
1760849004
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
345 Fuller Ave NE
Grand Rapids, MI 49503
Phone
(616) 608-8938
NPI assigned
Jan 18, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

345 Fuller Ave NE
Grand Rapids, MI 49503

Mailing address

PO Box 30516
Dept 5300
Lansing, MI 48909
Phone (231) 737-4374

Other practice location 1

945 E Sherman Blvd
Norton Shores, MI 49444-1805
Phone (231) 737-4374

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160523002231 MI Practitioner - Physical Therapist in Private Practice 4385933043 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Oakland College of Medicine and Surgery, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hulst Jepsen Physical Therapy IncGroup PAC ID 8325033285, 132 clinicians

Practice addresses (Care Compare)

17272 Robbins Rd
Suite 102
Grand Haven, MI 49417-2677
Phone (616) 256-8670

2120 43Rd St SE
Suite 100
Grand Rapids, MI 49508-3712
Phone (616) 281-1144

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Hulst Jepsen Physical Therapy Inc Physical Therapist CurrentSince Apr 11, 2022 Accepting new patients

Locations

17272 Robbins Rd
Ste 102
Grand Haven, MI 49417
Phone (616) 256-8670

2120 43rd St SE
Ste 100
Grand Rapids, MI 49508
Phone (616) 281-1144

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1453075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1760849004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30516",
            "address_2": "DEPT 5300",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "48909",
            "telephone_number": "231-737-4374",
            "fax_number": "231-830-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 FULLER AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-608-8938"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "945 E Sherman Blvd",
            "address_purpose": "LOCATION",
            "city": "Norton Shores",
            "state": "MI",
            "postal_code": "494441805",
            "country_code": "US",
            "telephone_number": "231-737-4374",
            "fax_number": "231-830-9196",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIERSMA",
        "first_name": "JILL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-18",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.