Individual provider Active NPI

Anastasiya Zubaryeva, PA-C

  • Physician Assistant
  • Traverse City, MI
National Provider Identifier
1124779475
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5315249289 Issued in MI
Practice address
3055 Cass Rd
Traverse City, MI 49684-7940
Phone
(231) 270-2100
NPI assigned
Jan 18, 2022
Sex
Female
Sole proprietor
Yes

Organizations & group practices 6

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.

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
I20230217001727 MI Practitioner - Physician Assistant 5092187138 Reassigns benefits to 6 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5315249289MIMDPhysician Assistant

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 5315249289 MI Primary

Addresses

NPPES NPI Registry

Primary practice location

3055 Cass Rd
Traverse City, MI 49684-7940

Mailing address

1105 Sixth St
Traverse City, MI 49684-2345
Phone (231) 935-5710

Other practice location 1

4100 Park Forest Dr Ste 208
Traverse City, MI 49684-7306
Phone (231) 935-5710

Other practice location 2

18000 W 9 Mile Rd Ste 525
Southfield, MI 48075-4080
Phone (248) 327-6196

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 7, 2025.

{
    "created_epoch": "1642464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1124779475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345",
            "telephone_number": "231-935-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 CASS RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847940",
            "telephone_number": "231-270-2100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4100 Park Forest Dr Ste 208",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496847306",
            "country_code": "US",
            "telephone_number": "231-935-5710",
            "fax_number": "231-935-9045",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18000 W 9 Mile Rd Ste 525",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480754080",
            "country_code": "US",
            "telephone_number": "248-327-6196",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZUBARYEVA",
        "first_name": "ANASTASIYA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-18",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5315249289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.