NPIMap

Individual provider Active NPI

Candace Atisha, PA-C

  • Medical Physician Assistant
  • Livonia, MI
National Provider Identifier
1407248537
Registry record updated Mar 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5601007299 Issued in MI
Practice address
37669 Pembroke Ave
Livonia, MI 48152-1050
Phone
(734) 793-6500
NPI assigned
Feb 26, 2015
Last updated
Mar 13, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601007299 MI Primary

Addresses

Primary practice location

37669 Pembroke Ave
Livonia, MI 48152-1050

Mailing address

37669 Pembroke Ave
Livonia, MI 48152-1050
Phone (734) 793-6500

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
I20150505001208 MI Practitioner - Physician Assistant 9931428414 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

27900 Grand River Ave
Suite 220
Farmington Hills, MI 48336-5965
Phone (248) 477-0552

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601007299MIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Healthcare Professionals PC CurrentSince Dec 1, 2020 Accepting new patients
Michigan Healthcare Professionals PC CurrentSince Dec 1, 2020 Accepting new patients
Apollo Family Health Services PC PastSince Nov 19, 2010 Accepting new patients

Locations

27900 Grand River Ave
Ste 220
Farmington Hills, MI 48336
Phone (248) 477-0552

29992 Northwestern Hwy
Ste C
Farmington Hills, MI 48334
Phone (248) 851-1430

37595 7 Mile Rd
Ste 240
Livonia, MI 48152
Phone (734) 432-7713

1221 Pine Grove Ave
Port Huron, MI 48060
Phone (810) 989-3300

Interoperability endpoints

  • Direct secure messaging: candace.atishapa.p1@direct.mhp.nextgenshare.com
  • Direct secure messaging: catisha1115590@direct.hfhs.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/CFHEBA

Organizations & group practices 3

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 11

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": "1424908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426204800000",
    "number": "1407248537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37669 PEMBROKE AVE",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481521050",
            "telephone_number": "734-793-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37669 PEMBROKE AVE",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481521050",
            "telephone_number": "734-793-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATISHA",
        "first_name": "CANDACE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-26",
        "last_updated": "2015-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601007299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

Verify at the official NPI Registry.