Individual provider Active NPI

Lesley Ann Nevenzel, PA-C

  • Physician Assistant
  • Muskegon, MI
National Provider Identifier
1093023228
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005892 Issued in MI
Practice address
2009 Holton Rd
Muskegon, MI 49445-1578
Phone
(616) 935-3479
NPI assigned
Sep 22, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

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 5601005892 MI Primary

Addresses

Primary practice location

2009 Holton Rd
Muskegon, MI 49445-1578

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address lnevenzel473964@epic00.shdirect.org
FHIR URL https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/

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
I20110125001261 MI Practitioner - Physician Assistant 7315126182 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

15100 Whittaker Way
Grand Haven, MI 49417-8696
Phone (616) 772-4644

2009 Holton Rd
Muskegon, MI 49445-1578
Phone (231) 291-8399

230 W Oak St
Fremont, MI 49412-1526

4100 Lake Dr SE
Grand Rapids, MI 49546-8292

4444 Kalamazoo Ave SE
200 Corewell Health Medical Group West
Kentwood, MI 49508-4600
Phone (616) 391-5600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Primary Care Partners CurrentSince Jun 6, 2022 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Jun 6, 2022 Accepting new patients
Spectrum Health Primary Care Partners Current Accepting new patients

Locations

230 W Oak St
Fremont, MI 49412
Phone (231) 924-1305

15100 Whittaker Way
Grand Haven, MI 49417
Phone (616) 935-6200

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

2009 Holton Rd
North Muskegon, MI 49445
Phone (231) 291-8020

Interoperability endpoints

  • Direct secure messaging: lnevenzel473964@epic00.corewelldirect.org
  • Direct secure messaging: lnevenzel473964@epic00.shdirect.org

Organizations & group practices 3

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 5

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": "1285113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654560000000",
    "number": "1093023228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2009 HOLTON RD",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494451578",
            "telephone_number": "616-935-3479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEVENZEL",
        "first_name": "LESLEY",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-22",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lnevenzel473964@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "2009 Holton Rd",
            "city": "Muskegon",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494451578",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2009 Holton Rd",
            "city": "Muskegon",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494451578",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

Verify at the official NPI Registry.