NPIMap

Individual provider Active NPI

Gina Renee Peterson, PA

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1497005474
Registry record updated Oct 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601006479 Issued in MI
Practice address
330 E Beltline Ave NE
Suite 100
Grand Rapids, MI 49506-1267
Phone
(616) 752-6235
Fax
(616) 328-8176
NPI assigned
Sep 17, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2015

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 5601006479 MI Primary

Addresses

Primary practice location

330 E Beltline Ave NE
Suite 100
Grand Rapids, MI 49506-1267

Mailing address

330 E Beltline Ave NE
Suite 100
Grand Rapids, MI 49506-1267
Phone (616) 752-6235

Other names 1

  • Gina Renee Blodgett Former name

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
I20121015000234 MI Practitioner - Physician Assistant 3476703166 Reassigns benefits to 2 organizations

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
Saint Mary'S Health ServicesGroup PAC ID 4981500436, 175 clinicians

Practice addresses (Care Compare)

1000 Edison Ave NW
Christian Rest Home
Grand Rapids, MI 49504-3918
Phone (616) 453-2475

1010 Edison Ave NW
Edison Assisted Living Center
Grand Rapids, MI 49504-3918
Phone (616) 453-0581

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.16 of 100Reported as group
Quality
95.73
Improvement activities
40
Cost
75.12

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601006479MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Mary'S Health Services Physician Assistant CurrentSince Sep 6, 2021 Accepting new patients
Advantage Health Saint Mary'S Medical Group Past Accepting new patients
West Michigan Heart Physician Assistant Past Accepting new patients

Locations

310 Lafayette Ave SE
Ste 315
Grand Rapids, MI 49503
Phone (616) 685-6222

Interoperability endpoints

  • Direct secure messaging: gpeterson36690@direct.trinity-health.org

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1347840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446163200000",
    "number": "1497005474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 E BELTLINE AVE NE",
            "address_2": "SUITE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495061267",
            "telephone_number": "616-752-6235",
            "fax_number": "616-328-8176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 E BELTLINE AVE NE",
            "address_2": "SUITE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495061267",
            "telephone_number": "616-752-6235",
            "fax_number": "616-328-8176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "GINA",
        "middle_name": "RENEE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-17",
        "last_updated": "2015-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GINA",
            "last_name": "BLODGETT",
            "middle_name": "RENEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.