Shana Goetting Broxup, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601010535TMP21 Issued in MI

Practice address

3230 Eagle Park Dr NE Ste 100
Grand Rapids, MI 49525-7047

Phone

(616) 988-2229

Fax

(616) 988-2010

NPI assigned

Aug 27, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: sbroxup135343@epic00.corewelldirect.org

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1326715202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8550 MOUNTAIN PINE LN",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490094992",
            "telephone_number": "517-896-9426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3230 EAGLE PARK DR NE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257047",
            "telephone_number": "616-988-2229",
            "fax_number": "616-988-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROXUP",
        "first_name": "SHANA",
        "middle_name": "GOETTING",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010535TMP21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Sbroxup@mrivf.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3230 Eagle Park Dr NE Ste 100",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495257047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• William Brown
• Melinda Browne, BSW
• Sean Alexander Browne
• Tricia Lynn Browneye, NP
• Kristine Marie Brownlow, PT
• Kim Marie Brubaker
• Russel Verne Brubaker, MD
• Bruce a. Jackson II, DDS, PLC
• Bruce D Dragoo MD PC
• Kelly Anne Bruch, RN, MSN, CNM

• Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.