NPIMap

Individual provider Active NPI

Nicole Elizabeth Simon, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1356830160
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601008583 Issued in MI
Practice address
1900 Wealthy St SE Ste 200
Grand Rapids, MI 49506-2969
Phone
(616) 774-0276
NPI assigned
May 7, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 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 5601008583 MI Primary

Addresses

Primary practice location

1900 Wealthy St SE Ste 200
Grand Rapids, MI 49506-2969

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Other names 1

  • Nicole Elizabeth Schafer Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address nsimon2915401@epic00.corewelldirect.org
FHIR URL https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/

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
I20180607001141 MI Practitioner - Physician Assistant 0547525883 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Spectrum Health HospitalsGroup PAC ID 8921904764, 161 clinicians

Practice addresses (Care Compare)

100 Michigan Ave NE
Grand Rapids, MI 49503-2560
Phone (616) 391-1774

100 Michigan St Northeast
Corewell Health Grand Rapids Hospit
Grand Rapids, MI 49503-2560
Phone (616) 391-1774

7 Atkinson Dr
Suite 302
Ludington, MI 49431-1917
Phone (616) 267-9823

705 Oak St
Unit 1
Big Rapids, MI 49307-3109
Phone (616) 267-9823

Hospital & facility affiliations

  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
  • Corewell Health Ludington Hospital Hospital, Ludington, MI, CCN 230110
  • Corewell Health Gerber Hospital Hospital, Fremont, MI, CCN 231338
  • Corewell Health Big Rapids Hospital Hospital, Big Rapids, MI, CCN 230093
  • St Lukes Hospital Hospital, Duluth, MN, CCN 240047

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5601008583MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary'S Medical Group Physician Assistant CurrentSince Jun 1, 2018 Accepting new patients
Spectrum Health Hospitals CurrentSince Nov 11, 2024 Accepting new patients
Advantage Health/Saint Mary'S Medical Group CurrentSince Jun 1, 2018 Accepting new patients
Spectrum Health Hospitals CurrentSince Nov 11, 2024 Accepting new patients

Locations

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

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

1900 Wealthy St SE
Ste 200
Grand Rapids, MI 49506
Phone (616) 459-0292

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

200 Jefferson Ave SE
Grand Rapids, MI 49503
Phone (616) 685-5000

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 31

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1525651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1356830160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 WEALTHY ST SE STE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495062969",
            "telephone_number": "616-774-0276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "NICOLE",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-07",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nsimon2915401@epic00.corewelldirect.org",
            "affiliation": "N",
            "address_1": "1900 Wealthy St SE Ste 200",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495062969",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "1900 Wealthy St SE Ste 200",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495062969",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "SCHAFER",
            "middle_name": "ELIZABETH",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.