Active NPI
Mackenzie Lauren Vandervelde, PA-C
- Physician Assistant
- Grand Rapids, MI
National Provider Identifier
1801614656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601012783
- Practice address
- 300 68TH St SE
Grand Rapids, MI 49548-6927 - Phone
- (616) 455-5000
- Fax
- (616) 455-5960
- NPI assigned
- Oct 1, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601012783 | MI | Primary |
Addresses
Primary practice location
300 68TH St SE
Grand Rapids, MI 49548-6927
Mailing address
300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000
Other practice location 1
655 Kenmoor Ave SE Ste 201
Grand Rapids, MI 49546-8604
Phone (616) 920-0825
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | pinerestCMHS@directaddress.pinerest.org | Direct |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000
655 Kenmoor Ave SE
Suite 201
Grand Rapids, MI 49546-8604
Phone (616) 920-0825
Hospital & facility affiliations
- Spectrum Health
- Corewell Health Ludington Hospital
- Corewell Health Zeeland Hospital
- Spectrum Health United Hospital
- Corewell Health Pennock Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601012783 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pine Rest Christian Mental Health Services | Current | Accepting new patients | |
| Pine Rest Christian Mental Health Services | Current | Accepting new patients |
Locations
300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000
Interoperability endpoints
- mvandervelde2908696@epic00.corewelldirect.org
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 and National Provider Directory roles.
-
- General Practice Physician
- Grand Rapids, MI
- NPI 1851309884
-
- Surgery Physician
- Grand Rapids, MI
- NPI 1710378989
-
- Professional Counselor
- Grand Rapids, MI
- NPI 1386015683
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Ludington, MI
- NPI 1972589489
-
- Critical Access Hospital
- Hastings, MI
- NPI 1932695525
-
- General Acute Care Hospital
- Grand Rapids, MI
- NPI 1922090554
-
- General Acute Care Hospital
- Greenville, MI
- NPI 1457304495
-
- General Acute Care Hospital
- Zeeland, MI
- NPI 1275536344
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773100800000",
"number": "1801614656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 68TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495486927",
"telephone_number": "616-455-5000",
"fax_number": "616-455-5960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 68TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495486927",
"telephone_number": "616-455-5000",
"fax_number": "616-455-5960"
}
],
"practiceLocations": [
{
"address_1": "655 Kenmoor Ave SE Ste 201",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495468604",
"country_code": "US",
"telephone_number": "616-920-0825",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VANDERVELDE",
"first_name": "MACKENZIE",
"middle_name": "LAUREN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-01",
"last_updated": "2026-03-10",
"certification_date": "2026-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601012783",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "pinerestCMHS@directaddress.pinerest.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "300 68th St SE",
"city": "Grand Rapids",
"state": "MI",
"country_code": "US",
"postal_code": "495486927",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Mar 10, 2026; 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.
- 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.