Pine Rest Christian Mental Health Services
NPI 1376554519ActiveOrganization· Physician Assistant· Grand Rapids, MI
Physician Assistant in Grand Rapids, Michigan, registered in NPPES in August 2006, part of Pine Rest Christian Mental Health Services. The authorized official on file is Diane Fennema, Manage Care Administrator.
Overview
| NPI | 1376554519 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Pine Rest Christian Mental Health Services |
| NPI issued | Aug 11, 2006 |
| Last updated in NPPES | Nov 4, 2020 |
| Certified by provider | Nov 4, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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