Individual provider Active NPI

Kimberly Sue Schommer, PA-C

  • Physician Assistant
  • Ypsilanti, MI
National Provider Identifier
1356368153
Registry record updated Jul 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004118 Issued in MI
Practice address
5325 Elliott Dr
Ypsilanti, MI 48197-8633
Phone
(734) 712-8000
Fax
(734) 712-4319
NPI assigned
Jul 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601004118 MI
Physician Assistant 363A00000X 5601004118 MI Primary

Addresses

Primary practice location

5325 Elliott Dr
Ypsilanti, MI 48197-8633

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

Other identifiers 1

IdentifierTypeStateIssuer
1356368153MedicaidMI

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
I20041223000098 MI Practitioner - Physician Assistant 1254399157 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Regents of the University of MichiganGroup PAC ID 3779496856, 3,344 clinicians

Practice addresses (Care Compare)

14650 E Old US Hwy 12
Chelsea, MI 48118-1801
Phone (734) 936-4000

1801 Briarwood Cir
Ann Arbor, MI 48108-3347
Phone (734) 539-5000

Hospital & facility affiliations

  • Chelsea Hospital Hospital, Chelsea, MI, CCN 230259

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601004118MIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan CurrentSince Oct 14, 2019 Accepting new patients
Regents of the University of Michigan Physician Assistant CurrentSince Oct 14, 2019 Accepting new patients
Regents of the University of Michigan Past Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

1500 E Medical Center Dr
Fl Cancer
Ann Arbor, MI 48109
Phone (734) 647-8902

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

1801 Briarwood Cir
Ann Arbor, MI 48108
Phone (734) 539-5000

3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229

Organizations & group practices 4

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": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563494400000",
    "number": "1356368153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5325 ELLIOTT DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481978633",
            "telephone_number": "734-712-8000",
            "fax_number": "734-712-4319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHOMMER",
        "first_name": "KIMBERLY",
        "middle_name": "SUE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-16",
        "last_updated": "2019-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601004118",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356368153",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.