NPIMap

Individual provider Active NPI

Wayne K McEwen, P.A.C.

  • Physician Assistant
  • Atlanta, MI
National Provider Identifier
1437101680
Registry record updated Feb 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
WM003886 Issued in MI
Practice address
11899 M 32
Atlanta, MI 49709-9374
Phone
(989) 785-4855
Fax
(989) 785-2267
NPI assigned
May 16, 2006
Last updated
Feb 23, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2010

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 WM003886 MI Primary

Addresses

Primary practice location

11899 M 32
Atlanta, MI 49709-9374

Mailing address

PO Box 427
Hillman, MI 49746-0427
Phone (989) 742-4583

Other identifiers 1

IdentifierTypeStateIssuer
0F06016OtherMIMEDICARE BILL PAY TO

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
I20041012001213 MI Practitioner - Physician Assistant 3577523844 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11899 M
Suite 32
Atlanta, MI 49709-9374
Phone (989) 785-4855

205 S Bradley Hwy
Rogers City, MI 49779-2137
Phone (989) 734-2052

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
WM003886MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Thunder Bay Community Health Service, Inc CurrentSince Jun 27, 2006 Accepting new patients
Thunder Bay Community Health Service, Inc CurrentSince Jun 27, 2006 Accepting new patients
Thunder Bay Community Health Service, Inc Past Accepting new patients
Thunder Bay Community Health Service, Inc Past Accepting new patients

Locations

11899 M 32
Atlanta, MI 49709
Phone (989) 785-4855

610 Caring St
Hillman, MI 49746
Phone (517) 742-4583

555 N Bradley Hwy
Rogers City, MI 49779
Phone (989) 734-2052

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 8

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266883200000",
    "number": "1437101680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 427",
            "city": "HILLMAN",
            "state": "MI",
            "postal_code": "497460427",
            "telephone_number": "989-742-4583",
            "fax_number": "989-742-4298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11899 M 32",
            "city": "ATLANTA",
            "state": "MI",
            "postal_code": "497099374",
            "telephone_number": "989-785-4855",
            "fax_number": "989-785-2267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCEWEN",
        "first_name": "WAYNE",
        "middle_name": "K",
        "credential": "P.A.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2010-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "WM003886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE BILL PAY TO",
            "identifier": "0F06016",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, MI

Sources for this page

Verify at the official NPI Registry.