Individual provider Active NPI

Jeneal M Duff, PA-C

  • Medical Physician Assistant
  • Byron Center, MI
National Provider Identifier
1346709052
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5601012103 Issued in MI
Practice address
2373 64TH St SW Ste 1300
Byron Center, MI 49315-7975
Phone
(872) 588-3000
NPI assigned
Mar 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 085.006970 IL
Medical Physician Assistant 363AM0700X 5601012103 MI Primary
Physician Assistant 363A00000X 085006970 IL

Addresses

Primary practice location

2373 64TH St SW Ste 1300
Byron Center, MI 49315-7975

Mailing address

2743 Olivia St NW
Grand Rapids, MI 49504-5894
Phone (317) 670-2912

Other identifiers 5

IdentifierTypeStateIssuer
5601012103OtherMISTATE LICENSE
1159852OtherILSPECIALTY BOARDS
5315244931OtherMICS LICENSE
385005452OtherILCS LICENSE
085006970OtherILSTATE LICENSE

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
I20240129000750 MI Practitioner - Physician Assistant 0143561241 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advantage Health/Saint Mary'S Medical GroupGroup PAC ID 4082807961, 499 clinicians
Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians
Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians

Practice addresses (Care Compare)

10047 Crossroad CT SE
Caledonia, MI 49316-7316
Phone (616) 685-8850

5060 Cascade Rd
Grand Rapids, MI 49546-3808

5060 Cascade Rd SE
Grand Rapids, MI 49546-3808

Hospital & facility affiliations

  • Mercy Health Saint Mary'S Hospital, Grand Rapids, MI, CCN 230059

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085006970ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health/Saint Mary'S Medical Group CurrentSince Feb 18, 2024 Accepting new patients
Advantage Health Saint Mary'S Medical Group Physician Assistant CurrentSince Feb 18, 2024 Accepting new patients
Advantage Health Saint Mary'S Medical Group Past Accepting new patients

Locations

2373 64th St SW
Ste 1300
Byron Center, MI 49315
Phone (616) 685-1350

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

Interoperability endpoints

  • Direct secure messaging: jduff3132609@direct.trinity-health.org

Organizations & group practices 5

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 1

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": "1552435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1346709052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2743 OLIVIA ST NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495045894",
            "telephone_number": "317-670-2912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2373 64TH ST SW STE 1300",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493157975",
            "telephone_number": "872-588-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUFF",
        "first_name": "JENEAL",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-13",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085.006970",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601012103",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006970",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5601012103",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECIALTY BOARDS",
            "identifier": "1159852",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CS LICENSE",
            "identifier": "5315244931",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CS LICENSE",
            "identifier": "385005452",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "085006970",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Byron Center, MI

Sources for this page

Verify at the official NPI Registry.