Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Regina R Koorndyk, PA

Individual provider Physician Assistant · NPI 1417050535

Regina R Koorndyk, PA is a Physician Assistant in Grand Rapids, Michigan. Qualified in 2005, 21 years ago. Practices with Spectrum Health Primary Care Partners, a 2,303-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Michigan.

Years since qualifying
21
Licensed in
MI
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

4100 Lake Dr SE Ste 200
Grand Rapids, MI 49546-8292
Phone: (616) 391-3759
Fax: (616) 391-3052
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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 5601004505 (MI)

Record details

NPI number1417050535
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedSeptember 6, 2006
Last updated in NPPESFebruary 25, 2021
Certification dateFebruary 25, 2021

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 Spectrum Health Primary Care Partners — 2303 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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