Active NPI
Marcie Gore, PA-C
- Physician Assistant
- Washington, MI
National Provider Identifier
1174961940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601006695
- Practice address
- 12150 30 Mile Rd
Washington, MI 48095-2035 - Phone
- (586) 752-7256
- NPI assigned
- Jun 13, 2013
- Last updated
- Jun 30, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601006695 | MI | Primary |
Addresses
Primary practice location
12150 30 Mile Rd
Washington, MI 48095-2035
Mailing address
12150 30 Mile Rd
Washington, MI 48095-2035
Other names 1
- Marcie Crandall
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Current Care of Michigan PC | Current | Accepting new patients | |
| American Current Care of Michigan PC | Current | Accepting new patients | |
| Orchardview Physicians | Past | Accepting new patients |
Locations
436 44th St SE
Ste A
Kentwood, MI 49548
Phone (616) 531-9750
11569 E 12 Mile Rd
Warren, MI 48093
Phone (586) 582-0018
Organizations & group practices 4
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.
-
dba Concentra Urgent Care
- Urgent Care Clinic/Center
- Grand Rapids, MI
- NPI 1659562262
-
- Occupational Medicine Physician
- Shelby Township, MI
- NPI 1245311398
-
dba Concentra Urgent Care
- Urgent Care Clinic/Center
- Warren, MI
- NPI 1477745495
-
dba Village Health Urgent & Family Care
- Urgent Care Clinic/Center
- Washington Township, MI
- NPI 1649435256
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435622400000",
"number": "1174961940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12150 30 MILE RD",
"city": "WASHINGTON",
"state": "MI",
"postal_code": "480952035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12150 30 MILE RD",
"city": "WASHINGTON",
"state": "MI",
"postal_code": "480952035",
"telephone_number": "586-752-7256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORE",
"first_name": "MARCIE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-13",
"last_updated": "2015-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601006695",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARCIE",
"last_name": "CRANDALL",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Washington, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.