Individual provider Active NPI

Zachary Tomasoski, PA-C

  • Medical Physician Assistant
  • Owosso, MI
National Provider Identifier
1417470469
Registry record updated Sep 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5315226798 Issued in MI
Practice address
1485 E M 21
Owosso, MI 48867-9048
Phone
(989) 494-0300
NPI assigned
Jul 21, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5315226798 MI Primary
Physician Assistant 363A00000X PA185145 OR

Addresses

Primary practice location

1485 E M 21
Owosso, MI 48867-9048

Mailing address

6020 W Pierson Rd
Flushing, MI 48433-2335
Phone (810) 407-7989

Other practice location 1

1445 Gateway Blvd
Cottage Grove, OR 97424-1224
Phone (541) 640-7625

Other practice location 2

2464 N Seymour Rd
Flushing, MI 48433-9741
Phone (810) 429-4107

Other practice location 3

48134 Highway 58
Oakridge, OR 97463-9601
Phone (541) 640-7625

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
I20210907000101 MI Practitioner - Physician Assistant 8022377282 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA185145ORMDPhysician Assistant
5315226798MIMDMedical Physician Assistant

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.

NPI Registry JSON

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

{
    "created_epoch": "1500595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1417470469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6020 W PIERSON RD",
            "city": "FLUSHING",
            "state": "MI",
            "postal_code": "484332335",
            "telephone_number": "810-407-7989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1485 E M 21",
            "city": "OWOSSO",
            "state": "MI",
            "postal_code": "488679048",
            "telephone_number": "989-494-0300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1445 Gateway Blvd",
            "address_purpose": "LOCATION",
            "city": "Cottage Grove",
            "state": "OR",
            "postal_code": "974241224",
            "country_code": "US",
            "telephone_number": "541-640-7625",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2464 N Seymour Rd",
            "address_purpose": "LOCATION",
            "city": "Flushing",
            "state": "MI",
            "postal_code": "484339741",
            "country_code": "US",
            "telephone_number": "810-429-4107",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "48134 Highway 58",
            "address_purpose": "LOCATION",
            "city": "Oakridge",
            "state": "OR",
            "postal_code": "974639601",
            "country_code": "US",
            "telephone_number": "541-640-7625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOMASOSKI",
        "first_name": "ZACHARY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-21",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5315226798",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA185145",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Owosso, MI

Sources for this page

Verify at the official NPI Registry.