Sally Vellenga

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704118351 Issued in MI

Practice address

8450 N 32ND St
Richland, MI 49083-9418

Phone

(269) 226-2500

NPI assigned

Aug 30, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Beacon Medical Group Michigan Inc

  dba Beacon Medical Group Michigan

  • Family Medicine Physician
  • Portage, MI
  • NPI 1497709869
  Medicare reassignment NPD
• Beacon Medical Group Michigan Inc

  dba Beacon Medical Group Michigan

  • Internal Medicine Physician
  • Portage, MI
  • NPI 1538299631

  Nurse Practitioner

  NPD
• Promed Healthcare

  dba Borgess Women's Health

  • Rural Health Clinic/Center
  • Plainwell, MI
  • NPI 1487708830
  NPD

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780794826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5943 STADIUM DR",
            "address_2": "SUITE 3",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490093016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8450 N 32ND ST",
            "city": "RICHLAND",
            "state": "MI",
            "postal_code": "490839418",
            "telephone_number": "269-226-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELLENGA",
        "first_name": "SALLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704118351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Joanne Sutherland, LMSW
• Trilogy Orthopedic Supply, Inc.
• Todd Duane Tucker, DDS
• Tracey S Tucker, DDS
• Joshua Vanderwall, MD
• Amanda Kay Fackler Wallace, LPC
• Stacey Watson
• Jonathan Michael Weiss, M.D.
• Chad Robert Westmaas, LPC
• Jacqueline Allen Wunderly, M.D.

• Nurse Practitioner in Richland, MI
• Providers in Richland, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.