Individual provider Active NPI

Leslie A Boonstra, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1770618522
Registry record updated Dec 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004592 Issued in MI
Practice address
550 Cherry St SE
Grand Rapids, MI 49503-4748
Phone
(616) 235-7272
Fax
(616) 776-2122
NPI assigned
Feb 22, 2007
Last updated
Dec 26, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601004592 MI Primary

Addresses

Primary practice location

550 Cherry St SE
Grand Rapids, MI 49503-4748

Mailing address

100 Cherry St SE
Grand Rapids, MI 49503-4526
Phone (616) 965-8200

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
I20130131000342 MI Practitioner - Physician Assistant 4880848738 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cherry Street Services IncGroup PAC ID 6800707647, 58 clinicians

Practice addresses (Care Compare)

550 Cherry St SE
Grand Rapids, MI 49503-4748
Phone (616) 235-7272

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cherry Street Services, Inc. CurrentSince Dec 9, 2012 Accepting new patients
Cherry Street Services, Inc CurrentSince Dec 9, 2012 Accepting new patients
Cherry Street Health Services Past Accepting new patients

Locations

100 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 965-8209

550 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 235-7272

669 Stocking Ave NW
Grand Rapids, MI 49504
Phone (616) 235-1480

Interoperability endpoints

  • Direct secure messaging: leslie.boonstra.p1@direct.cherryhealth.nextgenshare.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356480000000",
    "number": "1770618522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CHERRY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034526",
            "telephone_number": "616-965-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 CHERRY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034748",
            "telephone_number": "616-235-7272",
            "fax_number": "616-776-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOONSTRA",
        "first_name": "LESLIE",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2012-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.