Devan Dykstra

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4351044757 Issued in MI

Practice address

21400 E 11 Mile Rd
Saint Clair Shores, MI 48081-1566

Phone

(586) 498-4400

NPI assigned

Jun 27, 2019

Sex

Male

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Wayne State University School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cherry Street Services IncGroup PAC ID 6800707647, 58 clinicians

Advantage Health/Saint Mary'S Medical GroupGroup PAC ID 4082807961, 499 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Health Saint Mary'S Hospital, Grand Rapids, MI, CCN 230059
• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ddykstra4569920@direct.trinity-health.org
• Direct secure messaging: ddykstra524345@direct.hfhs.org

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.

• Advantage Health/Saint Mary'S Medical Group

  • Multi-Specialty Clinic/Center
  • Grand Rapids, MI
  • NPI 1376862151
  Medicare reassignment Care Compare group NPD
• Cherry Street Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Grand Rapids, MI
  • NPI 1558459164

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Advantage Health Saint Mary'S Medical Group

  • Orthopaedic Surgery Physician
  • Byron Center, MI
  • NPI 1003515008
  NPD
• Advantage Health Saint Mary'S Medical Group

  • Multi-Specialty Clinic/Center
  • Grand Rapids, MI
  • NPI 1952340911
  NPD
• Cherry Street Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Howard City, MI
  • NPI 1831955251
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Saint Mary'S Health Services

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1639111057
  Care Compare affiliation
• Spectrum Health Hospitals

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

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

{
    "created_epoch": "1561593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561593600000",
    "number": "1902467061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21400 E 11 MILE RD",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21400 E 11 MILE RD",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811566",
            "telephone_number": "586-498-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYKSTRA",
        "first_name": "DEVAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-27",
        "last_updated": "2019-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4351044757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Dufon, LLC
• Riley Duryea
• Amy Marie Duval
• Norman Paul Dwaihy, PHD
• Heather Dyer
• Kenneth John Dziuba, M.D.
• Andrew I. Dzul, M.D.
• E&N Greater Mack Practices PLLC
• E&N Greater Mack Practices PLLC
• East Side Foot & Ankle Clinic PC

• Family Medicine Physician in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2019; 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.

Verify at the official NPI Registry.