Evan Steven Gravedoni, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601012281 Issued in MI

Practice address

10854 M 32 E
Johannesburg, MI 49751-9622

Phone

(989) 785-5894

Fax

(989) 318-4606

NPI assigned

Dec 15, 2022

Last updated

Oct 7, 2026By the provider in NPPES

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Thunder Bay Community Health Service IncGroup PAC ID 0143296772, 39 clinicians

McLaren Central MichiganGroup PAC ID 6103733092, 183 clinicians

Northsport Physical Therapy and Rehabilitation P CGroup PAC ID 5294902508, shared by 2 NPIs, 43 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLaren Northern Michigan Hospital, Petoskey, MI, CCN 230105
• McLaren Central Michigan Hospital, Mount Pleasant, MI, CCN 230080
• Munson Healthcare Otsego Memorial Hospital Hospital, Gaylord, MI, CCN 230133

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• McLaren Central Michigan

  • General Acute Care Hospital
  • Mt Pleasant, MI
  • NPI 1245266063
  Medicare reassignment Care Compare group
• Thunder Bay Community Health Service, Inc

  • Federally Qualified Health Center (FQHC)
  • Hillman, MI
  • NPI 1629107552
  Medicare reassignment Care Compare group
• McLaren Central Michigan

  • Family Medicine Physician
  • Mt Pleasant, MI
  • NPI 1710235775
  NPD
• McLaren Central Michigan

  • Rural Health Clinic/Center
  • Gladwin, MI
  • NPI 1841812989
  NPD
• McLaren Central Michigan

  • General Acute Care Hospital
  • Mt Pleasant, MI
  • NPI 1538195409
  NPD (past)
• Thunder Bay Community Health Service, Inc

  • Federally Qualified Health Center (FQHC)
  • Mio, MI
  • NPI 1750751392
  NPD (past)

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

• McLaren Central Michigan

  • Rural Acute Care Hospital
  • Mt Pleasant, MI
  • NPI 1619941317
  Care Compare affiliation
• McLaren Northern Michigan

  • Psychiatric Hospital Unit
  • Cheboygan, MI
  • NPI 1336897735
  Care Compare affiliation
• McLaren Northern Michigan

  • General Acute Care Hospital
  • Petoskey, MI
  • NPI 1992812580
  Care Compare affiliation
• Munson Healthcare Otsego Memorial Hospital

  • General Acute Care Hospital
  • Gaylord, MI
  • NPI 1124028972
  Care Compare affiliation

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

{
    "created_epoch": "1671062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791331200000",
    "number": "1083326557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 427",
            "city": "HILLMAN",
            "state": "MI",
            "postal_code": "497460427",
            "telephone_number": "989-785-5894",
            "fax_number": "989-318-4606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10854 M 32 E",
            "city": "JOHANNESBURG",
            "state": "MI",
            "postal_code": "497519622",
            "telephone_number": "989-785-5894",
            "fax_number": "989-318-4606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVEDONI",
        "first_name": "EVAN",
        "middle_name": "STEVEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-12-15",
        "last_updated": "2026-10-07",
        "certification_date": "2026-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Traci A Doran, LMSW
• Samantha Johnson-Klein
• Sara L McMichael
• Laura Rea, LPC
• Jillian Ross, LMSW
• Thunder Bay Community Health Service, Inc (Johannesburg-Lewiston Area Schools)

• Physician Assistant in Johannesburg, MI
• Providers in Johannesburg, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2026; 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.