Individual provider Active NPI

Samuel Alexander Merchun, PA-C

  • Medical Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1093462202
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
4100 Embassy Dr SE Ste 400
Grand Rapids, MI 49546-2416
Phone
(616) 988-8220
NPI assigned
Mar 8, 2022
Last updated
Mar 8, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

4100 Embassy Dr SE Ste 400
Grand Rapids, MI 49546-2416

Mailing address

7160 Cuesta Way Dr NE
Rockford, MI 49341-9493
Phone (616) 826-9787

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
I20220404002466 MI Practitioner - Physician Assistant 0143616953 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
83.79 of 100Reported as group
Quality
79.33
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
97.48 of 100Reported as group
Quality
89.26
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Radiology Services PC PastSince Mar 13, 2022 Accepting new patients

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

NPI Registry JSON

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

{
    "created_epoch": "1646697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646697600000",
    "number": "1093462202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7160 CUESTA WAY DR NE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493419493",
            "telephone_number": "616-826-9787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 EMBASSY DR SE STE 400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462416",
            "telephone_number": "616-988-8220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERCHUN",
        "first_name": "SAMUEL",
        "middle_name": "ALEXANDER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-08",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.