Individual provider Active NPI

Kelsey Lyn Brown, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1477858850
Registry record updated Oct 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601007825 Issued in MI
Practice address
4069 Lake Dr SE
Grand Rapids, MI 49546-8816
Phone
(616) 267-7469
NPI assigned
Jan 17, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2021

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 5601007825 MI Primary

Addresses

Primary practice location

4069 Lake Dr SE
Grand Rapids, MI 49546-8816

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/
Direct Messaging Address kbrown135498@epic00.shdirect.org

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
I20161208000772 MI Practitioner - Physician Assistant 6901046259 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Primary Care Partners CurrentSince Dec 19, 2016 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Dec 19, 2016 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Oct 1, 2020 Accepting new patients

Locations

4069 Lake Dr SE
Grand Rapids, MI 49546
Phone (616) 267-7469

2249 Wealthy St SE
Ste 110
Grand Rapids, MI 49506
Phone (616) 391-4600

2750 E Beltline Ave NE
Grand Rapids, MI 49525
Phone (616) 267-7015

2332 Alpine Ave NW
Grand Rapids, MI 49544
Phone (616) 363-3311

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

444 Michigan St NE
#288
Grand Rapids, MI 49503
Phone (616) 267-7469

4075 32nd Ave
Hudsonville, MI 49426
Phone (616) 229-9310

3350 Broadmoor Ave SE
Kentwood, MI 49512
Phone (616) 391-2778

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

80 68th St SE
Kentwood, MI 49548
Phone (616) 391-8220

6105 Wilson Ave SW
Wyoming, MI 49418
Phone (616) 486-5055

Interoperability endpoints

  • Direct secure messaging: kbrown135498@epic00.corewelldirect.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1295222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1477858850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4069 LAKE DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468816",
            "telephone_number": "616-267-7469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "KELSEY",
        "middle_name": "LYN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-17",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "444 Michigan St NE # Mc288",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495033317",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbrown135498@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "444 Michigan St NE # Mc288",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495033317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.