Individual provider Active NPI

Angela Nicole Egmon, PA-C

  • Physician Assistant
  • Jackson, MI
National Provider Identifier
1063199198
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601012377 Issued in MI
Practice address
1100 E Michigan Ave Ste 307
Jackson, MI 49201-1850
Phone
(517) 205-1594
NPI assigned
Jun 30, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2082 NH
Physician Assistant 363A00000X 5601012377 MI Primary

Addresses

Primary practice location

1100 E Michigan Ave Ste 307
Jackson, MI 49201-1850

Mailing address

1100 E Michigan Ave Ste 307
Jackson, MI 49201-1850
Phone (517) 205-1594

Other practice location 1

1 Medical Center Dr
Lebanon, NH 03756-0001
Phone (603) 650-5000

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240708001305 MI Practitioner - Physician Assistant 3072968064 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7845 Spring Arbor Rd
Spring Arbor, MI 49283-9785
Phone (517) 205-2580

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2082NHMDMental Health Counselor
5601012377MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dartmouth-Hitchcock Clinic CurrentSince Sep 18, 2023 Accepting new patients
Mary Hitchcock Memorial Hospital CurrentSince Sep 18, 2023 Accepting new patients
W.a. Foote Memorial Hospital, Inc Physician Assistant CurrentSince Jun 24, 2024 Accepting new patients
Dartmouth-Hitchcock Clinic CurrentSince Sep 18, 2023 Accepting new patients
Mary Hitchcock Memorial Hospital CurrentSince Sep 18, 2023 Accepting new patients
W.a. Foote Memorial Hospital, Inc CurrentSince Jun 24, 2024 Accepting new patients
Wa Foote Memorial Hospital, Inc Physician Assistant Past Accepting new patients

Locations

1 Ford Pl
Ste 3A
Detroit, MI 48202
Phone (313) 874-2892

813 W Michigan Ave
Jackson, MI 49202
Phone (517) 205-1000

1100 E Michigan Ave
Jackson, MI 49201
Phone (517) 205-7605

1100 E Michigan Ave
Ste 307
Jackson, MI 49201
Phone (517) 205-1594

7845 Spring Arbor Rd
Spring Arbor, MI 49283
Phone (517) 205-2580

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

Interoperability endpoints

  • Direct secure messaging: aegmon1035879@direct.hfhs.org

Organizations & group practices 8

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1688083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1063199198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 E MICHIGAN AVE STE 307",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011850",
            "telephone_number": "517-205-1594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E MICHIGAN AVE STE 307",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011850",
            "telephone_number": "517-205-1594"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "NH",
            "postal_code": "037560001",
            "country_code": "US",
            "telephone_number": "603-650-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EGMON",
        "first_name": "ANGELA",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-30",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "2082",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.