Jennifer J. Koetje, PA
Individual provider Active NPI Medical Physician Assistant · Whitehall, MI
NPI 1912908997 · NPPES record last updated Jan 21, 2024
Key facts
- NPI
- 1912908997
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 5601002222 (MI)
- Practice address
- 116 W Colby St Ste D
Whitehall, MI 49461-1084 - Phone
- (231) 292-1240
- Fax
- (231) 292-1088
- NPI assigned
- Aug 2, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Compass Pointe Medical PLLC
Practice addresses (Care Compare)
116 W Colby St
Suite D
Whitehall, MI 49461-1084
Phone (231) 292-1240
Hospital & facility affiliations
- Trinity Health Muskegon Hospital
- Mercy Health Lakeshore Campus
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070306000286 | MI | Practitioner - Physician Assistant | 1153424528 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601002222 | MI | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Health Partners | Current |
Accepting new patients | |
| Mercy Specialty Services | Past | Accepting new patients | |
| Newaygo County General Hospital Association | Past | Accepting new patients | |
| Newaygo County General Hospital Association | Past | Accepting new patients |
Locations
71 Bevier St
Shelby, MI 49455
Phone (231) 861-2172
905 E Colby St
Whitehall, MI 49461
Phone (231) 672-8050
Interoperability endpoints
- jennifer.koetje.1@29755.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5601002222 | MI | Yes |
Addresses
Primary practice location
116 W Colby St Ste D
Whitehall, MI 49461-1084
Mailing address
116 W Colby St Ste D
Whitehall, MI 49461-1084
Phone (231) 292-1240
Other providers in Whitehall, MI
- Wayne Stewart Jackson
- Kima Johnson
- Kelly'S Kare Afc
- Kellys Kare Community Life Skills LLC
- Joseph Gerard Kerschen
- James Lynn Kolbe
- Melanie R Lahrman
- Lakeshore Community Hospital Inc.
- Lakeshore Community Hospital, Inc.
- Lakeshore Community Hospital, Inc.
All providers in Whitehall, MI · Medical Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.