Organization Active NPI

Elite Wound Experts

  • Physician Assistant
  • Kentwood, MI
National Provider Identifier
1487520789
Registry record updated Jul 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
ELITE WOUND EXPERTS
Practice address
5924 Bramalea Ave SE
Kentwood, MI 49508-6421
Phone
(616) 616-5987
Fax
(616) 616-6044
NPI assigned
Oct 14, 2025
Last updated
Jul 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2026

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

Authorized official

Name
Shawna Miller
Title
Director of RCM
Phone
(616) 226-5202

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

5924 Bramalea Ave SE
Kentwood, MI 49508-6421

Mailing address

8739 Rainbows End Rd SE
Caledonia, MI 49316-7525
Phone (616) 616-5987

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260223002403 MI Part B Supplier - Clinic/Group Practice 9234610700 Receives reassigned benefits from 2 practitioners
Practice locations: Kentwood, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1760400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783468800000",
    "number": "1487520789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8739 RAINBOWS END RD SE",
            "city": "CALEDONIA",
            "state": "MI",
            "postal_code": "493167525",
            "telephone_number": "616-616-5987",
            "fax_number": "616-616-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5924 BRAMALEA AVE SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495086421",
            "telephone_number": "616-616-5987",
            "fax_number": "616-616-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE WOUND EXPERTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-14",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "DIRECTOR OF RCM",
        "authorized_official_telephone_number": "616-226-5202"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kentwood, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.