NPIMap

Individual provider Active NPI

Kristine Shango, PA-C

  • Physician Assistant
  • Rochester Hills, MI
National Provider Identifier
1316772866
Registry record updated Sep 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601012712 Issued in MI
Practice address
811 South Blvd E Ste 200
Rochester Hills, MI 48307-5359
Phone
(248) 651-0800
NPI assigned
Sep 4, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 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 5601012712 MI Primary

Addresses

Primary practice location

811 South Blvd E Ste 200
Rochester Hills, MI 48307-5359

Mailing address

7454 Timbers Edge Blvd
West Bloomfield, MI 48322-3335
Phone (248) 866-9098

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
I20251005000126 MI Practitioner - Physician Assistant 2860998127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

7454 Timbers Edge Blvd
West Bloomfield, MI 48322-3335

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601012712MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ghiath Tayeb MD PC CurrentSince Jun 15, 2025 Accepting new patients

Locations

811 South Blvd E
Ste 200
Rochester Hills, MI 48307
Phone (248) 651-0800

Interoperability endpoints

  • Direct secure messaging: kshango2913857@epic00.corewelldirect.org

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 12

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": "1725408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725753600000",
    "number": "1316772866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7454 TIMBERS EDGE BLVD",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483223335",
            "telephone_number": "248-866-9098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 SOUTH BLVD E STE 200",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483075359",
            "telephone_number": "248-651-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANGO",
        "first_name": "KRISTINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-04",
        "last_updated": "2024-09-08",
        "certification_date": "2024-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester Hills, MI

Sources for this page

Verify at the official NPI Registry.