Individual provider Active NPI

Peter Tran Nguyen, PA-C

  • Physician Assistant
  • Muskegon, MI
National Provider Identifier
1396417416
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1670 E Sherman Blvd
Muskegon, MI 49444-1863
Phone
(231) 244-2271
NPI assigned
Sep 28, 2021
Last updated
Aug 9, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 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 Primary

Addresses

Primary practice location

1670 E Sherman Blvd
Muskegon, MI 49444-1863

Mailing address

1670 E Sherman Blvd
Muskegon, MI 49444-1863

Other practice location 1

1091 S Beacon Blvd
Grand Haven, MI 49417-2607
Phone (616) 604-0096

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
I20211116001068 MI Practitioner - Physician Assistant 5294124129 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Synanon IncGroup PAC ID 6204899172, 7 clinicians
Salubrious Health PLLCGroup PAC ID 6507225992, 10 clinicians

Practice addresses (Care Compare)

1091 S Beacon Blvd
Grand Haven, MI 49417-2607
Phone (616) 842-3600

91 Douglas Ave
Suite 110
Holland, MI 49424-2183
Phone (616) 298-8124

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Services Corporation CurrentSince Nov 15, 2023 Accepting new patients
Iha Health Service Corporation CurrentSince Nov 15, 2023 Accepting new patients

Locations

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

Interoperability endpoints

  • Direct secure messaging: peter.nguyen.1@22386.direct.athenahealth.com
  • Direct secure messaging: pnguyen787337@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1632787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723161600000",
    "number": "1396417416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 E SHERMAN BLVD",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 E SHERMAN BLVD",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441863",
            "telephone_number": "231-244-2271"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1091 S Beacon Blvd",
            "address_purpose": "LOCATION",
            "city": "Grand Haven",
            "state": "MI",
            "postal_code": "494172607",
            "country_code": "US",
            "telephone_number": "616-604-0096",
            "fax_number": "616-604-0095",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "PETER",
        "middle_name": "TRAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-28",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

Verify at the official NPI Registry.