Mark F Gillette, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601002367 Issued in MI

Practice address

3355 Eagle Park Dr NE
Suite 103
Grand Rapids, MI 49525-7004

Phone

(616) 942-7400

Fax

(616) 942-7405

NPI assigned

Mar 24, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Age Management of West Michigan PCGroup PAC ID 2466686290, 23 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Spectrum Health United Hospital Hospital, Greenville, MI, CCN 230035

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Age Management of West Michigan PC

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1558700625
  Medicare reassignment Care Compare group
• Iah of Michigan, PLLC

  • Family Medicine Physician
  • Troy, MI
  • NPI 1578969705
  Medicare reassignment
• LTC Physician Care PC

  • Geriatric Medicine (Family Medicine) Physician
  • Bingham Farms, MI
  • NPI 1841991817
  Medicare reassignment
• Vpa PC

  • Family Medicine Physician
  • Portage, MI
  • NPI 1669091864
  Medicare reassignment
• Vpa PC

  • Clinical Social Worker
  • Troy, MI
  • NPI 1639637754
  NPD
• Vpa PC

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Troy, MI
  • NPI 1871666784
  NPD
• Vpa PC

  • Family Medicine Physician
  • Brentwood, TN
  • NPI 1578363362
  NPD
• MGH Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Muskegon, MI
  • NPI 1255331583
  NPD (past)
• Michigan Medical Patient Care

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1073567806
  NPD (past)
• Michigan Medical Patient Care

  • Durable Medical Equipment & Medical Supplies
  • Holland, MI
  • NPI 1871741652
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Spectrum Health United

  • General Acute Care Hospital
  • Greenville, MI
  • NPI 1457304495
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404950400000",
    "number": "1043482680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1239",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480991239",
            "telephone_number": "248-824-6600",
            "fax_number": "855-618-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 EAGLE PARK DR NE",
            "address_2": "SUITE 103",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257004",
            "telephone_number": "616-942-7400",
            "fax_number": "616-942-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLETTE",
        "first_name": "MARK",
        "middle_name": "F",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-24",
        "last_updated": "2014-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601002367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Kristen Gillard
• Michael John Gillen, M.S.W.
• Jospeh Gillengerten
• Paige Allison Gillespie, LMSW
• Emily Renae Gillette, OD
• Simone Gilliam
• Margaret Grace Gillich
• Taylor Jeanne Gillis
• Erin Gillmet
• Andrea Gillon, NP

• Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.