NPIMap

Individual provider Active NPI

Andre Vincent Hollingsworth, M.D.

  • Internal Medicine Physician
  • Byron Center, MI
National Provider Identifier
1801184247
Registry record updated Jul 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301099153 Issued in MI
Practice address
2373 64TH St SW
Byron Center, MI 49315-7974
Phone
(616) 685-1350
Fax
(616) 261-7191
NPI assigned
Jul 19, 2011
Last updated
Jul 20, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2015

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 4301099153 MI Primary
Pediatrics Physician 208000000X 4301099153 MI

Addresses

Primary practice location

2373 64TH St SW
Byron Center, MI 49315-7974

Mailing address

1900 44TH St SE
Kentwood, MI 49508-5008

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
I20150615001915 MI Practitioner - Internal MedicinePractitioner - Pediatric Medicine 8921235961 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2373 64TH St SW
Suite 1300
Byron Center, MI 49315-7975
Phone (616) 685-1350

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group CurrentSince Jul 1, 2015 Accepting new patients
Baxter Community Center CurrentSince Apr 1, 2018 Accepting new patients
Advantage Health/Saint Mary's Medical Group CurrentSince Jul 1, 2015 Accepting new patients
Saint Mary's Health Services Past Accepting new patients
Advantage Health Saint Mary's Medical Group Past Accepting new patients

Locations

2373 64th St SW
Byron Center, MI 49315
Phone (616) 685-1350

2373 64th St SW
Ste 1300
Byron Center, MI 49315
Phone (616) 685-1350

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

935 Baxter St SE
Grand Rapids, MI 49506
Phone (616) 215-4544

1175 Wilson Ave NW
Walker, MI 49534
Phone (616) 284-3686

4310 Leonard St NW
Ste 103
Walker, MI 49534
Phone (616) 453-0600

Interoperability endpoints

  • Direct secure messaging: ahollingsworth32559@direct.trinity-health.org

Organizations & group practices 5

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 3

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": "1311033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437350400000",
    "number": "1801184247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 44TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2373 64TH ST SW",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493157974",
            "telephone_number": "616-685-1350",
            "fax_number": "616-261-7191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLINGSWORTH",
        "first_name": "ANDRE",
        "middle_name": "VINCENT",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-19",
        "last_updated": "2015-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301099153",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301099153",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Byron Center, MI

Sources for this page

Verify at the official NPI Registry.