Active NPI
Halli Disbrow
- Physician Assistant
- Grand Rapids, MI
National Provider Identifier
1215510862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601013927
- Practice address
- 3500 Lake Dr SE
Grand Rapids, MI 49546-4310 - Phone
- (616) 475-7577
- NPI assigned
- May 2, 2021
- Reactivated
- Mar 7, 2025
- 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 | 5601013927 | MI | Primary |
Addresses
Primary practice location
3500 Lake Dr SE
Grand Rapids, MI 49546-4310
Mailing address
3500 Lake Dr SE
Grand Rapids, MI 49546-4310
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
PO Box
Chicago, IL 60677
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601013927 | MI | MD | Physician Assistant |
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.
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- Muskegon, MI
- NPI 1124042700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778112000000",
"number": "1215510862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 LAKE DR SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495464310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 LAKE DR SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495464310",
"telephone_number": "616-475-7577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISBROW",
"first_name": "HALLI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-02",
"last_updated": "2026-05-07",
"certification_date": "2026-05-07",
"deactivation_date": "2024-11-25",
"reactivation_date": "2025-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601013927",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.