John A Dykstra, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601001358 Issued in MI

Practice address

3019 Coit Ave NE
Grand Rapids, MI 49505-3376

Phone

(616) 365-9575

NPI assigned

Jul 27, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952325110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2074 126TH AVE",
            "city": "HOPKINS",
            "state": "MI",
            "postal_code": "493289768",
            "telephone_number": "616-365-9575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3019 COIT AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495053376",
            "telephone_number": "616-365-9575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYKSTRA",
        "first_name": "JOHN",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601001358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alissa Audrey Dykstra
• Ashley Renee Dykstra, LMSW
• Holly Dykstra, RD
• Janice Lynne Dykstra, LPC
• Jason P Dykstra, MD
• Joseph Henry Dykstra, ATC
• Kevin James Dykstra, MDIV, MA, LLPC
• Kristin Dykstra, PA-C
• Lois R Dykstra, RN
• Marsha Dykstra, LPC

• Medical Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.