Individual provider Active NPI

Wendy Jane Koopman, N.P.

  • Family Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1891728069
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704195455 Issued in MI
Practice address
5800 Foremost Dr SE Ste 100
Grand Rapids, MI 49546-7062
Phone
(616) 954-5554
NPI assigned
Jul 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704195455 MI Primary

Addresses

Primary practice location

5800 Foremost Dr SE Ste 100
Grand Rapids, MI 49546-7062

Mailing address

5800 Foremost Dr SE Ste 300
Grand Rapids, MI 49546-7062
Phone (616) 954-9800

Other names 1

  • Wendy Jane Palmbos Former name

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
I20061026000352 MI Practitioner - Nurse Practitioner 2860499324 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

12460 Riley St
Holland, MI 49424-8217
Phone (616) 399-6500

145 Michigan St NE
Suite 3100
Grand Rapids, MI 49503-2563
Phone (616) 954-9800

5800 Foremost Dr SE
Grand Rapids, MI 49546-7062
Phone (616) 954-9800

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
96
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cancer & Hematology Centers of Western Mi, P.C. CurrentSince Nov 1, 2006 Accepting new patients
Cancer & Hematology Centers of Western Mi, P.C. Past Accepting new patients
Cancer & Hematology Centers of Western Mi, P.C. Past Accepting new patients

Locations

710 Kenmoor Ave SE
Ste 200
Grand Rapids, MI 49546
Phone (616) 588-7246

145 Michigan St NE
Ste 3100
Grand Rapids, MI 49503
Phone (616) 954-9800

710 Kenmoor Ave SE
Grand Rapids, MI 49546
Phone (616) 389-1800

5800 Foremost Dr SE
Ste 300
Grand Rapids, MI 49546
Phone (616) 389-1725

5800 Foremost Dr SE
Ste 100
Grand Rapids, MI 49546
Phone (616) 954-5554

1440 E Sherman Blvd
Ste 200
Muskegon, MI 49444
Phone (231) 332-5871

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.

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1891728069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 FOREMOST DR SE STE 300",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467062",
            "telephone_number": "616-954-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 FOREMOST DR SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467062",
            "telephone_number": "616-954-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOPMAN",
        "first_name": "WENDY",
        "middle_name": "JANE",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-09",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704195455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WENDY",
            "last_name": "PALMBOS",
            "middle_name": "JANE",
            "credential": "N.P.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.