Individual provider Active NPI

Eyoome K Agbley, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1457724965
Registry record updated Nov 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601007847 Issued in MI
Practice address
3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone
(616) 363-7272
Fax
(616) 361-5828
NPI assigned
Nov 5, 2015
Last updated
Nov 18, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601007847 MI Primary
Physician Assistant 363A00000X 1001984A IN

Addresses

Primary practice location

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746

Mailing address

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone (616) 363-7272

Other names 1

  • Kwabea E Agbley Former name

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
I20160908002760 MI Practitioner - Physician Assistant 6305148024 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Radiology Services PCGroup PAC ID 4284546516, 252 clinicians

Practice addresses (Care Compare)

100 Michigan Ave NE
Grand Rapids, MI 49503-2560
Phone (616) 363-7272

1009 W Green St
Hastings, MI 49058-1710
Phone (616) 363-7272

1234 Napier Ave
Saint Joseph, MI 49085-2112
Phone (616) 363-7272

14544 Georgian Bay Dr
Holland, MI 49424-7535
Phone (616) 363-7272

1501 W Chisholm St
Alpena, MI 49707-1401
Phone (616) 363-7272

1855 Boardwalk
Saint Joseph, MI 49085-9664
Phone 61636372721046

1987 Navaho TRL
Okemos, MI 48864-2721
Phone (616) 363-7272

2610 Old Lake Shore Rd
Saint Joseph, MI 49085-1863
Phone 61636372721046

292 Yarmouth Rd
Bloomfield Hills, MI 48301-2745
Phone (616) 363-7272

300 N Ave
Battle Creek, MI 49017-3307
Phone (616) 363-7272

3099 Churchhill LN
Apt 4
Saginaw, MI 48603-4312
Phone (616) 363-7272

3121 Oak LN
Stevensville, MI 49127-9346
Phone (616) 363-7272

3653 Whicker Pointe
Kalamazoo, MI 49006-6413
Phone (616) 363-7272

3700 Lake Birch St NE
Grand Rapids, MI 49525-8606
Phone (616) 363-7272

4999 W Village CT SE
Ada, MI 49301-7609
Phone (616) 363-7272

524 S Park St
Kalamazoo, MI 49007-5118
Phone (616) 363-7272

5325 Ridge Rd
Stevensville, MI 49127-1000
Phone (616) 363-7272

6460 S Bluebird Ave E
Fremont, MI 49412-7660
Phone (616) 363-7272

6715 Apple Blossom LN
Kalamazoo, MI 49009-7488
Phone 61636373391046

859 Majestic
Rochester Hills, MI 48306-3574
Phone (616) 363-7272

9652 Maricopa TRL
Kalamazoo, MI 49009-4957
Phone (616) 363-7272

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.33 of 100Reported as group
Quality
91.31
Improvement activities
40
Cost
79.05

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1001984AINMDPhysician Assistant
5601007847MIMDPhysician 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1446681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763424000000",
    "number": "1457724965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7272",
            "fax_number": "616-361-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7272",
            "fax_number": "616-361-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGBLEY",
        "first_name": "EYOOME",
        "middle_name": "K",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-05",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007847",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "1001984A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KWABEA",
            "last_name": "AGBLEY",
            "middle_name": "E",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.