NPIMap

Individual provider Active NPI

Jennifer Radewahn, PA

  • Physician Assistant
  • Saginaw, MI
National Provider Identifier
1134496292
Registry record updated Nov 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005792 Issued in MI
Practice address
4705 Towne Ctr
Ste 102
Saginaw, MI 48604-2818
Phone
(989) 790-2941
Fax
(989) 790-2983
NPI assigned
Nov 17, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2011

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 5601005792 MI Primary

Addresses

Primary practice location

4705 Towne Ctr
Ste 102
Saginaw, MI 48604-2818

Mailing address

4705 Towne Ctr
Ste 102
Saginaw, MI 48604-2818
Phone (989) 790-2941

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130215000016 MI Practitioner - Physician Assistant 5597919894 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
Group practices

Practice addresses (Care Compare)

4705 Towne Centre Rd
Suite 102
Saginaw, MI 48604-2820
Phone (989) 497-3144

Hospital & facility affiliations

  • Elara Caring Home health agency, Bingham Farms, MI, CCN 239000
  • Covenant Medical Center Hospital, Saginaw, MI, CCN 230070
  • Mymichigan Medical Center Saginaw Hospital, Saginaw, MI, CCN 230077
  • Mymichigan Medical Center Midland Hospital, Midland, MI, CCN 230222
  • Tawas St Joseph Hospital Hospital, Tawas City, MI, CCN 230100
  • McLaren Bay Region Hospital, Bay City, MI, CCN 230041

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601005792MIMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: jennifer.radewahn.1@29770.direct.athenahealth.com

Organizations & group practices 1

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1321488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321488000000",
    "number": "1134496292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 TOWNE CTR",
            "address_2": "STE 102",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486042818",
            "telephone_number": "989-790-2941",
            "fax_number": "989-790-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 TOWNE CTR",
            "address_2": "STE 102",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486042818",
            "telephone_number": "989-790-2941",
            "fax_number": "989-790-2983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADEWAHN",
        "first_name": "JENNIFER",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-17",
        "last_updated": "2011-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.