Individual provider Active NPI

Amy Ebbing, PA-C

  • Physician Assistant
  • Clinton Township, MI
National Provider Identifier
1265930747
Registry record updated Feb 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601008551 Issued in MI
Practice address
15855 19 Mile Rd
Clinton Township, MI 48038-3504
Phone
(586) 263-2601
NPI assigned
Jan 30, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2021

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 5601008551 MI Primary

Addresses

Primary practice location

15855 19 Mile Rd
Clinton Township, MI 48038-3504

Mailing address

3470 Shakespeare Dr
Troy, MI 48084-1489
Phone (248) 918-8537

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aebbing441215@direct.hfhs.org

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
I20180412002850 MI Practitioner - Physician Assistant 9234492844 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

12150 30 Mile Rd
Suite 201
Washington Township, MI 48095-2035
Phone (586) 336-2380

15717 15 Mile Rd
Clinton Township, MI 48035-2101

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601008551MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Macomb Hospital Corporation Physician Assistant CurrentSince Mar 10, 2018 Accepting new patients
Henry Ford Health System CurrentSince Nov 1, 2020 Accepting new patients
Henry Ford Health System Physician Assistant CurrentSince Nov 1, 2020 Accepting new patients
Henry Ford Macomb Hospital Corporation CurrentSince Mar 10, 2018 Accepting new patients
Henry Ford Pathology Current Accepting new patients

Locations

15717 15 Mile Rd
Clinton Twp, MI 48035
Phone (586) 285-3800

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2300

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

12150 30 Mile Rd
Ste 105
Washington Twp, MI 48095
Phone (586) 336-7333

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 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": "1517270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1265930747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3470 SHAKESPEARE DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480841489",
            "telephone_number": "248-918-8537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15855 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480383504",
            "telephone_number": "586-263-2601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBBING",
        "first_name": "AMY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-30",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aebbing441215@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "15855 19 Mile Rd",
            "city": "Clinton Township",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480383504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

Verify at the official NPI Registry.