NPIMap

Individual provider Active NPI

Eric Paul Rose, PA-C

  • Physician Assistant
  • Kalamazoo, MI
National Provider Identifier
1083123012
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601008415 Issued in MI
Practice address
601 John St
Kalamazoo, MI 49007-5341
Phone
(269) 341-7654
NPI assigned
Sep 21, 2017
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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 5601008415 MI Primary

Addresses

Primary practice location

601 John St
Kalamazoo, MI 49007-5341

Mailing address

3444 Cottage Cove Dr
Fenton, MI 48430-1300
Phone (989) 708-7801

Other practice location 1

601 John St
Kalamazoo, MI 49007-5341
Phone (269) 341-7654

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
I20180130000375 MI Practitioner - Physician Assistant 9032479613 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mayo Mitsuya, PLLCGroup PAC ID 0345571964, 2 clinicians
Arja MD PCGroup PAC ID 8325368467, 4 clinicians

Practice addresses (Care Compare)

1375 N Main St
Lapeer, MI 48446-1350
Phone (810) 667-5500

1739 N Saginaw St
Suite 104a
Lapeer, MI 48446-7627
Phone (989) 708-7801

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Theoria Medical Physician Assistant CurrentSince Apr 19, 2021 Accepting new patients
Amd Primary Care, PLLC PastSince Jul 21, 2015 Accepting new patients
Wellbridge of Clarkston, LLC Past Accepting new patients

Locations

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

Interoperability endpoints

  • Direct secure messaging: eric.rose.1@16087.direct.athenahealth.com

Organizations & group practices 10

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

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": "1505952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1083123012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3444 COTTAGE COVE DR",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484301300",
            "telephone_number": "989-708-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-341-7654"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 John St",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490075341",
            "country_code": "US",
            "telephone_number": "269-341-7654",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSE",
        "first_name": "ERIC",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-21",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.