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Individual provider Active NPI

Gabrielle Joan Stanton, PA

  • Physician Assistant
  • White Lake, MI
National Provider Identifier
1154052868
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601011851 Issued in MI
Practice address
2870 Mystic Valley Dr
White Lake, MI 48383-3292
Phone
(248) 464-3141
NPI assigned
Jun 22, 2022
Last updated
Aug 29, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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 5601011851 MI Primary

Addresses

Primary practice location

2870 Mystic Valley Dr
White Lake, MI 48383-3292

Mailing address

2870 Mystic Valley Dr
White Lake, MI 48383-3292
Phone (248) 464-3141

Other practice location 1

27810 Grand River Ave
Farmington Hills, MI 48336-5916
Phone (248) 516-1978

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
I20240906002341 MI Practitioner - Physician Assistant 6103366067 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstreet Urgent Care of MichiganGroup PAC ID 6305188491, 129 clinicians

Practice addresses (Care Compare)

19760 Haggerty Rd
Beaumont Urgent Care of Michigan
Livonia, MI 48152-1080
Phone (734) 793-8769

2078 E Big Beaver Rd
Beaumont Urgent Care of Michigan
Troy, MI 48083-2301
Phone (248) 918-0744

25631 Little Mack Ave
Suite 104
Saint Clair Shores, MI 48081-2100
Phone (586) 884-2727

27810 Grand River Ave
Farmington Hills, MI 48336-5916
Phone (248) 957-1989

29263 Orchard Lake Rd
Farmington Hills, MI 48334-2953
Phone (248) 488-5900

42757 Woodward Ave
Beaumont Urgent Care by Wellstreet
Bloomfield Hills, MI 48304-5037
Phone (248) 940-4937

43535 Grand River Ave
Novi, MI 48375-1108
Phone (248) 946-4500

6470 Orchard Lake Rd
West Bloomfield, MI 48322-2337
Phone (248) 419-8019

6543 Telegraph Rd
Bloomfield Township, MI 48301-3066
Phone (248) 940-4751

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstreet Urgent Care of Michigan PastSince Aug 6, 2023 Accepting new patients
Wellstreet Urgent Care of Michigan PastSince Aug 6, 2023 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.

Hospital & facility affiliations 11

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": "1655856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1154052868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2870 MYSTIC VALLEY DR",
            "city": "WHITE LAKE",
            "state": "MI",
            "postal_code": "483833292",
            "telephone_number": "248-464-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2870 MYSTIC VALLEY DR",
            "city": "WHITE LAKE",
            "state": "MI",
            "postal_code": "483833292",
            "telephone_number": "248-464-3141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27810 Grand River Ave",
            "address_purpose": "LOCATION",
            "city": "Farmington Hills",
            "state": "MI",
            "postal_code": "483365916",
            "country_code": "US",
            "telephone_number": "248-516-1978",
            "fax_number": "248-516-1979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STANTON",
        "first_name": "GABRIELLE",
        "middle_name": "JOAN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-22",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Lake, MI

Sources for this page

Verify at the official NPI Registry.