Individual provider Active NPI

Rachel Kisnonsky, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1407609589
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601012330 Issued in MI
Practice address
145 Michigan St NE Ste 3100
Grand Rapids, MI 49503-2563
Phone
(616) 954-9800
NPI assigned
Apr 9, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 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 5601012330 MI Primary

Addresses

Primary practice location

145 Michigan St NE Ste 3100
Grand Rapids, MI 49503-2563

Mailing address

145 Michigan St NE Ste 3100
Grand Rapids, MI 49503-2563
Phone (616) 954-9800

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
I20240424002577 MI Practitioner - Physician Assistant 8224478243 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

145 Michigan St NE
Suite 3100
Grand Rapids, MI 49503-2563
Phone (616) 954-9800

15100 220TH Ave
Big Rapids, MI 49307-9248
Phone (231) 515-9410

Hospital & facility affiliations

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: rkisnonsky3352194@direct.trinity-health.org

Organizations & group practices 1

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 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": "1712620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1407609589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 MICHIGAN ST NE STE 3100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032563",
            "telephone_number": "616-954-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 MICHIGAN ST NE STE 3100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032563",
            "telephone_number": "616-954-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISNONSKY",
        "first_name": "RACHEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-09",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.