Individual provider Active NPI

Katie Helene Farrell, PA

  • Physician Assistant
  • Saint Joseph, MI
National Provider Identifier
1366968695
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601008115 Issued in MI
Practice address
1234 Napier Ave
Saint Joseph, MI 49085-2112
Phone
(269) 983-3455
Fax
(269) 983-5920
NPI assigned
Aug 18, 2017
Last updated
Mar 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

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 5601008115 MI Primary

Addresses

Primary practice location

1234 Napier Ave
Saint Joseph, MI 49085-2112

Mailing address

1234 Napier Ave
Saint Joseph, MI 49085-2112
Phone (269) 983-3455

Other practice location 1

815 Saint Joseph Dr
Saint Joseph, MI 49085-2529
Phone (269) 983-3455

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
I20170926000160 MI Practitioner - Physician Assistant 5890069157 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Barry University School of Podiatric Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Practice addresses (Care Compare)

1234 Napier Ave
Corewell Health Lakeland Hospitals
Saint Joseph, MI 49085-2112
Phone (269) 983-8300

3950 Hollywood Rd
Saint Joseph, MI 49085-9151

9623 Red Arrow Hwy
Bridgman, MI 49106-9559
Phone (269) 465-6050

9625 Red Arrow Hwy
Bridgman, MI 49106-9559
Phone (269) 465-6050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601008115MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince Aug 19, 2024 Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince Aug 19, 2024 Accepting new patients
Lakeland Medical Practices CurrentSince Sep 1, 2017 Accepting new patients

Locations

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

3950 Hollywood Rd
Ste 210
Saint Joseph, MI 49085
Phone (269) 556-1990

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

815 Saint Joseph Dr
Saint Joseph, MI 49085
Phone (269) 982-4272

Interoperability endpoints

  • Direct secure messaging: kfarrell1269389@epic00.corewelldirect.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1503014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741824000000",
    "number": "1366968695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 NAPIER AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852112",
            "telephone_number": "269-983-3455",
            "fax_number": "269-983-5920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 NAPIER AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852112",
            "telephone_number": "269-983-3455",
            "fax_number": "269-983-5920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "815 Saint Joseph Dr",
            "address_purpose": "LOCATION",
            "city": "Saint Joseph",
            "state": "MI",
            "postal_code": "490852529",
            "country_code": "US",
            "telephone_number": "269-983-3455",
            "fax_number": "269-983-5920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FARRELL",
        "first_name": "KATIE",
        "middle_name": "HELENE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-18",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MI

Sources for this page

Verify at the official NPI Registry.