Active NPI
Joan L Eddy, PA
- Physician Assistant
- Grayling, MI
National Provider Identifier
1083642979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 003238
- Practice address
- 1100 E Michigan Ave
Grayling, MI 49738-1312 - Phone
- (989) 348-5461
- NPI assigned
- Jun 29, 2006
- Last updated
- Jun 3, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 003238 | MI | Primary |
Addresses
Primary practice location
1100 E Michigan Ave
Grayling, MI 49738-1312
Mailing address
2000 Green Rd
Suite 300
Ann Arbor, MI 48105-1598
Phone (734) 995-3764
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003238 | MI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212451200000",
"number": "1083642979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 GREEN RD",
"address_2": "SUITE 300",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481051598",
"telephone_number": "734-995-3764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 E MICHIGAN AVE",
"city": "GRAYLING",
"state": "MI",
"postal_code": "497381312",
"telephone_number": "989-348-5461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDDY",
"first_name": "JOAN",
"middle_name": "L",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-29",
"last_updated": "2008-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "003238",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grayling, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.