Trang H Phan, PA-C
Individual provider Active NPI Medical Physician Assistant · Essexville, MI
NPI 1295919280 · NPPES record last updated Dec 28, 2007
Key facts
- NPI
- 1295919280
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 5601004098 (MI)
- Practice address
- 1003 Woodside Ave
Essexville, MI 48732-1234 - Phone
- (989) 892-7722
- Fax
- (989) 892-7455
- NPI assigned
- Dec 26, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2003
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
220 S Ensley St
Howard City, MI 49329-8656
Phone (231) 937-6226
Hospital & facility affiliations
- Corewell Health Big Rapids Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Medics PC |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Corporate Officer (100%) W-2 Managing Employee (100%) |
Jun 27, 2018 Jun 27, 2018 Jun 27, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040916000328 | MI | Practitioner - Physician Assistant | 9830166024 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601004098 | MI | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Accelerated Care of Michigan | Physician Assistant | Past | Accepting new patients |
| Medics PC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5601004098 | MI | Yes |
Addresses
Primary practice location
1003 Woodside Ave
Essexville, MI 48732-1234
Mailing address
4300 Milan Ave SW
Wyoming, MI 49509-4427
Phone (616) 204-1094
Other providers in Essexville, MI
- Ansuya S Patel
- Adarsh Meher Nisanth Patri
- PC Script Inc
- Kari Peckham
- Sonya Roxanne Pfaffenbach
- Timothy Phillips
- Thomas D Plamondon Jr.
- Taegan Alycia Pletzke
- Podcare PC
- Kayle Rose Polega
All providers in Essexville, MI · Medical Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.