NPIMap

Individual provider Active NPI

Shawndelin Marie Brunsman, P.A.-C

  • Physician Assistant
  • Saint Clair Shores, MI
National Provider Identifier
1063789014
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601006201 Issued in MI
Practice address
28963 Little Mack Ave Ste 101
Saint Clair Shores, MI 48081-3017
Phone
(586) 447-0700
Fax
(586) 447-0795
NPI assigned
Nov 18, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601006201 MI Primary

Addresses

Primary practice location

28963 Little Mack Ave Ste 101
Saint Clair Shores, MI 48081-3017

Mailing address

28963 Little Mack Ave Ste 101
Saint Clair Shores, MI 48081-3017
Phone (586) 447-0700

Other names 1

  • Shawndelin Marie Wilson Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140121000920 MI Practitioner - Physician Assistant 5597993568 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Semi Medical GroupGroup PAC ID 0648180406, shared by 4 NPIs, 246 clinicians
Gi Medical Assoc PCGroup PAC ID 3375525215, 11 clinicians
Blue Water Urgent Care PLLCGroup PAC ID 8123427895, 22 clinicians

Practice addresses (Care Compare)

17900 23 Mile Rd
Macomb, MI 48044-1161
Phone (313) 647-3900

2700 Pointe Tremble Rd
Algonac, MI 48001-1836
Phone (810) 662-2827

28963 Little Mack Ave
Suite 101
Saint Clair Shores, MI 48081-3017
Phone (586) 447-0700

Hospital & facility affiliations

  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
  • Beaumont Hospital - Grosse Pointe Hospital, Grosse Pointe, MI, CCN 230089
  • Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269
  • Henry Ford Macomb Hospital Hospital, Clinton Township, MI, CCN 230047
  • Henry Ford Health Warren Hospital Hospital, Warren, MI, CCN 230195

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Water Urgent Care New Baltimore PastSince Jan 8, 2023 Accepting new patients

Organizations & group practices 6

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 8

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": "1321574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1063789014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28963 LITTLE MACK AVE STE 101",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813017",
            "telephone_number": "586-447-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28963 LITTLE MACK AVE STE 101",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813017",
            "telephone_number": "586-447-0700",
            "fax_number": "586-447-0795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNSMAN",
        "first_name": "SHAWNDELIN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-18",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHAWNDELIN",
            "last_name": "WILSON",
            "middle_name": "MARIE",
            "credential": "P.A.-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.