Individual provider Active NPI

Katrina Celeste Hamel, PA-C

  • Physician Assistant
  • Berrien Springs, MI
National Provider Identifier
1194075002
Registry record updated Feb 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
9045 US Highway 31
Suite a
Berrien Springs, MI 49103-1804
Phone
(269) 473-2222
Fax
(269) 473-6880
NPI assigned
Sep 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2016

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 Primary

Addresses

Primary practice location

9045 US Highway 31
Suite a
Berrien Springs, MI 49103-1804

Mailing address

9045 US Highway 31
Suite a
Berrien Springs, MI 49103-1804
Phone (269) 473-2222

Other names 1

  • Ms. Katrina Celeste Rebolloso Former name

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
I20121205000264 MI Practitioner - Physician Assistant 8729230305 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Practice addresses (Care Compare)

3950 Hollywood Rd
Saint Joseph, MI 49085-9151

9045 US Hwy 31
Berrien Springs, MI 49103-1804

Hospital & facility affiliations

  • Corewell Health Lakeland Hospitals St Joseph Hospital Home health agency, Benton Harbor, MI, CCN 237163
  • Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021
  • Corewell Health Watervliet Hospital Hospital, Watervliet, MI, CCN 230078

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Medical Practices CurrentSince Dec 1, 2019 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Aug 11, 2015 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Aug 11, 2015 Accepting new patients
Lakeland Medical Practices CurrentSince Dec 1, 2019 Accepting new patients

Locations

9045 US Highway 31
Berrien Springs, MI 49103
Phone (269) 473-2222

9045 US Highway 31
Ste A
Berrien Springs, MI 49103
Phone (269) 473-2222

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

400 Medical Park Dr
Watervliet, MI 49098
Phone (269) 463-3111

Interoperability endpoints

  • Direct secure messaging: khamel1269752@epic00.corewelldirect.org

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.

Hospital & facility affiliations 3

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": "1347926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455667200000",
    "number": "1194075002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9045 US HIGHWAY 31",
            "address_2": "SUITE A",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "491031804",
            "telephone_number": "269-473-2222",
            "fax_number": "269-473-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9045 US HIGHWAY 31",
            "address_2": "SUITE A",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "491031804",
            "telephone_number": "269-473-2222",
            "fax_number": "269-473-6880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMEL",
        "first_name": "KATRINA",
        "middle_name": "CELESTE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-18",
        "last_updated": "2016-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATRINA",
            "last_name": "REBOLLOSO",
            "middle_name": "CELESTE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Berrien Springs, MI

Sources for this page

Verify at the official NPI Registry.