Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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John J Mulder IV, PA-C

Individual provider Physician Assistant · NPI 1124009071

John J Mulder IV, PA-C is a Physician Assistant in Grand Rapids, Michigan. Qualified in 2005, 21 years ago. Practices with Advantage Health/Saint Mary's Medical Group, a 494-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
21
Licensed in
MI
In the registry since
2005
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

100 Michigan St NE
Grand Rapids, MI 49503-2560
Phone: (616) 391-3431
Fax: (616) 391-2783
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601004510 (MI)

Record details

NPI number1124009071
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedNovember 8, 2005
Last updated in NPPESJanuary 8, 2026
Certification dateJanuary 8, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Advantage Health/Saint Mary'S Medical Group — 494 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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