Individual provider Active NPI

Ca Shawnda Lynn Range, PA-C

  • Physician Assistant
  • Ann Arbor, MI
National Provider Identifier
1295854016
Registry record updated Sep 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601003114 Issued in MI
Practice address
1500 E Medical Center Dr
B1 Floor Taubman Center Recp Mos
Ann Arbor, MI 48109-5317
Phone
(734) 232-2867
NPI assigned
Mar 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601003114 MI Primary
Medical Physician Assistant 363AM0700X 5601003114 MI

Addresses

Primary practice location

1500 E Medical Center Dr
B1 Floor Taubman Center Recp Mos
Ann Arbor, MI 48109-5317

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110815000623 MI Practitioner - Physician Assistant 0547439234 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601003114MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Healthcare Professionals PC CurrentSince May 1, 2015 Accepting new patients
Michigan Healthcare Professionals PC CurrentSince May 1, 2015 Accepting new patients

Locations

2050 N Haggerty Rd
Ste B1
Canton, MI 48187
Phone (734) 656-1190

1 William Carls Dr
Commerce Twp, MI 48382
Phone (248) 227-5500

27900 Grand River Ave
Ste 220
Farmington Hills, MI 48336
Phone (248) 477-0552

29992 Northwestern Hwy
Ste C
Farmington Hills, MI 48334
Phone (248) 851-1430

33545 Cherry Hill Rd
Westland, MI 48186
Phone (734) 595-1166

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252627200000",
    "number": "1295854016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DR",
            "address_2": "B1 FLOOR TAUBMAN CENTER RECP MOS",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095317",
            "telephone_number": "734-232-2867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANGE",
        "first_name": "CA",
        "middle_name": "SHAWNDA LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2009-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003114",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601003114",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.