Ross Kooienga, PA-C

Key facts

NPI

1992158745

Entity type

Individual (NPI type 1)

Primary specialty

Physician Assistant 363A00000X

Practice address

100 Michigan St NE
Grand Rapids, MI 49503-2560

Phone

(616) 486-6790

Fax

(616) 486-6702

NPI assigned

Jul 18, 2016

Sex

Male

Sole proprietor

No

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.

• Spectrum Health Primary Care Partners Internal Medicine Physician · Grand Rapids, MI · NPI 1235188673
  Medicare reassignment Care Compare group NPD MI
• Spectrum Health Primary Care Partners Pediatric Endocrinology Physician · Grand Rapids, MI · NPI 1326599671
  NPD
• Spectrum Health Primary Care Partners Internal Medicine Physician · Grand Rapids, MI · NPI 1689499667
  NPD

Hospital & facility affiliations 3

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

• Mecosta County Medical Center General Acute Care Hospital · Big Rapids, MI · NPI 1316945991
  Care Compare affiliation Hospital
• Pennock Hospital Critical Access Hospital · Hastings, MI · NPI 1932695525
  Care Compare affiliation Hospital
• Spectrum Health Hospitals General Acute Care Hospital · Grand Rapids, MI · NPI 1922090554
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spectrum Health Primary Care Partners (2,283 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Spectrum Health Hospital · Grand Rapids, MI · CCN 230038
• Corewell Health Big Rapids Hospital Hospital · Big Rapids, MI · CCN 230093

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

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rkooienga134976@epic00.corewelldirect.org

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 25, 2021.

{
    "created_epoch": "1468800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1992158745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MAIL CODE 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-486-6790",
            "fax_number": "616-486-6702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOIENGA",
        "first_name": "ROSS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-18",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rkooienga134976@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "100 Michigan St NE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "100 Michigan St NE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

• Annalie Konyndyk, M.A. CCC-SLP
• Sarah Konynenbelt
• Emily Kooi
• William Blake Kooi, MA, LPC, QIDP
• Christopher Kooienga
• Kevin Kooiker, D.D.S
• Nicole Kooiker, D.D.S
• Payton Jon Kooiker, DO
• Joshua S Kooistra, DO
• Melissa A Kooistra, PA

All providers in Grand Rapids, MI · Physician Assistant in Michigan