NPIMap

Individual provider Active NPI

Kaela Nicole Crall

  • Physician Assistant
  • Northville, MI
National Provider Identifier
1225845506
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601012686 Issued in MI
Practice address
46706 Crystal Downs W
Northville, MI 48168-8456
Phone
(316) 218-2401
NPI assigned
Dec 11, 2024
Last updated
Dec 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 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 5601012686 MI Primary

Addresses

Primary practice location

46706 Crystal Downs W
Northville, MI 48168-8456

Mailing address

46706 Crystal Downs W
Northville, MI 48168-8456
Phone (316) 218-2401

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
I20250117000241 MI Practitioner - Physician Assistant 4688102767 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLaren Hospital GroupGroup PAC ID 2365968351, 366 clinicians
McLaren Central MichiganGroup PAC ID 6103733092, 183 clinicians

Practice addresses (Care Compare)

401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-2000

560 W Mitchell St
Suite C70
Petoskey, MI 49770-2275
Phone (231) 487-7200

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Northern Michigan CurrentSince Dec 29, 2024 Accepting new patients
McLaren Northern Michigan CurrentSince Dec 29, 2024 Accepting new patients
McLaren Hospital Group CurrentSince Nov 11, 2025 Accepting new patients

Locations

401 S Ballenger Hwy
Flint, MI 48532
Phone (810) 342-1000

2390 Mitchell Park Dr
Ste D
Petoskey, MI 49770
Phone (231) 242-1760

416 Connable Ave
Petoskey, MI 49770
Phone (231) 487-4000

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.

Hospital & facility affiliations 9

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": "1733875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1225845506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46706 CRYSTAL DOWNS W",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481688456",
            "telephone_number": "316-218-2401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46706 CRYSTAL DOWNS W",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481688456",
            "telephone_number": "316-218-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRALL",
        "first_name": "KAELA",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-11",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northville, MI

Sources for this page

Verify at the official NPI Registry.