Pine Rest Christian Mental Health Services
NPI 1467463604ActiveOrganization· Nurse Practitioner· Grand Rapids, MI
Nurse Practitioner in Grand Rapids, Michigan, registered in NPPES in August 2006, part of Pine Rest Christian Mental Heatlh Services. The authorized official on file is Diane Fennema, Managed Care Administrator. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1467463604 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Pine Rest Christian Mental Heatlh 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 |
|---|---|---|---|
| Nurse Practitioner Primary | 363L00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MI) |
|---|
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