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Benjamin J Bruinsma

Physical Medicine & Rehabilitation

Allopathic & Osteopathic Physicians

235 Wealthy St SE, Suite 100, Grand Rapids, MI 49503-5229

PECOS Enrollment

This provider is enrolled in PECOS as BENJAMIN BRUINSMA.

Based on the most recent information from CMS, provider Benjamin J Bruinsma is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 10:10 AM.

Profile Details

Provider ID
1508804154
Provider Type
Individual
Full Name
Bruinsma, Benjamin J
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
6/4/2006
Last Updated
3/31/2021

Contact Information

Practice Location

235 Wealthy St SE, Suite 100, Grand Rapids, MI 49503-5229

(616) 840-8186

(616) 840-9637

Mailing Location

235 Wealthy St SE, Suite 100, Grand Rapids, MI 49503-5247

(616) 840-8186

(616) 840-9637

Provider Taxonomies

Code	Description	License
Code 208100000X Primary	Description Physical Medicine & Rehabilitation Allopathic & Osteopathic Physicians	License 4301405949 Michigan

Provider Identifiers

ID	Description	Issuer
ID 2577423	Description Medicaid	Issuer Unlisted Michigan
ID BB405949	Description Other	Issuer STATE LICENSE Michigan

Benjamin J Bruinsma

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Mousigian, Marianne

Smith, Lauren Elizabeth

Deshpande, Aashish A

Lamm, Adam

Mary Free Bed Rehabiltation Hospital

Rose, Alexander

Vodapally, Shashank

Nicholson, Joshua Turner

Yablon, Stuart A

Kramer, Jeffrey H