Individual provider Active NPI

Kristine A Cononico, PA

  • Surgical Physician Assistant
  • Mt Pleasant, MI
National Provider Identifier
1245260710
Registry record updated Feb 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
5601004397 Issued in MI
Practice address
1221 South Dr
Mt Pleasant, MI 48858-3258
Phone
(989) 772-6700
NPI assigned
Jul 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 5601004397 MI Primary

Addresses

Primary practice location

1221 South Dr
Mt Pleasant, MI 48858-3258

Mailing address

1221 South Dr
Mt Pleasant, MI 48858-3258
Phone (989) 772-6700

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
I20041228000293 MI Practitioner - Physician Assistant 9638137474 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Petoskey Surgeons, P.C.Group PAC ID 4880616028, 9 clinicians

Practice addresses (Care Compare)

521 Monroe St
Petoskey, MI 49770-2266
Phone (231) 487-1900

860 N Ctr Ave
Gaylord, MI 49735-1510
Phone (989) 732-4400

Hospital & facility affiliations

  • McLaren Northern Michigan Hospital, Petoskey, MI, CCN 230105

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601004397MIMDSurgical 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.

Hospital & facility affiliations 2

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": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360886400000",
    "number": "1245260710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 SOUTH DR",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488583258",
            "telephone_number": "989-772-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 SOUTH DR",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488583258",
            "telephone_number": "989-772-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONONICO",
        "first_name": "KRISTINE",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2013-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601004397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Pleasant, MI

Sources for this page

Verify at the official NPI Registry.