MARIA E DIMUSTO-POORTENGA MD
NPI 1013940980
Pediatrics - Neonatal-Perinatal Medicine in Grand Rapids, MI

Q: What is Maria Dimusto-poortenga's NPI number?

The NPI number for Maria Dimusto-poortenga is 1013940980. It was assigned to this individual provider in the NPPES registry on July 7, 2006. The provider is also known as Mariel Elizabeth Dimustopoortenga MD.

Q: What is Maria Dimusto-poortenga's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Neonatal-Perinatal Medicine, with taxonomy code 2080N0001X.

Active since July 07, 2006PECOS Enrolled

200 JEFFERSON AVE SE, NICU, GRAND RAPIDS, MI 49503(616) 752-6554 Get Directions Write a Review

NPPES record last updated: December 5, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 5, 2023, Feb 28, 2022, Feb 11, 2022 (3 updates tracked since 2022).

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About Maria E Dimusto-poortenga Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARIA E DIMUSTO-POORTENGA MD (NPI 1013940980) is an individual neonatal-perinatal medicine provider in Grand Rapids, Michigan, licensed in Michigan (4301068818) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS and maintains a secondary practice location in Marion.

NPPES Registry Identity

NPI1013940980

Entity TypeIndividualFemale

Primary Taxonomy2080N0001X

Provider Legal NameMARIA E DIMUSTO-POORTENGACredential: MD

Location Address200 JEFFERSON AVE SE, NICUGrand Rapids, MI 49503-4502

Mailing Address245 State St SeGrand Rapids, MI 49503-4328 · Fax (616) 913-1818

Phone(616) 752-6554

Sole ProprietorNo

Enumeration DateJuly 7, 2006

Last NPPES UpdateDecember 5, 20233 updates tracked since enumeration

NPPES CertifiedDecember 5, 2023

✔ NPI 1013940980 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Neonatal-Perinatal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080N0001X

Licenses✔ Licensed in MI · 4301068818✔ Licensed in OH · 35C001071✔ Licensed in MI · 1013940980✔ Licensed in FL · ME141884

Definition

A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.

Also ListedPediatricsTaxonomy 208000000X · License 4301068818 (MI)

200 JEFFERSON AVE SE, Grand Rapids, MI 49503

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Other Names 1

Other Name (5)Mariel Elizabeth Dimustopoortenga Md

Secondary Practice Location 1

Location 11000 McKinley Park DrMarion, OH 43302-6399 · Phone (740) 383-8400

Other Identifiers 3

Medicaid0031359OH

Medicaid4120849MI

Medicaid4877886MI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Priority Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Maria E Dimusto-poortenga Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATHARINE LIND THOMPSON PT

Physical Therapist