Regina South, PA-C
Individual provider Active NPI Medical Physician Assistant · Carleton, MI
NPI 1497704142 · NPPES record last updated Jan 30, 2008
Key facts
- NPI
- 1497704142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 5601003551 (MI)
- Practice address
- 130 Medical Center Dr
Carleton, MI 48117-9461 - Phone
- (734) 654-2169
- Fax
- (734) 654-6535
- NPI assigned
- May 9, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Family Medical Center of Michigan Inc
Practice addresses (Care Compare)
130 Medical Ctr Dr
Carleton, MI 48117-9461
Phone (734) 654-2169
8765 Lewis Ave
Temperance, MI 48182-9583
Phone (734) 847-3802
Hospital & facility affiliations
- Promedica Monroe Regional Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140317000656 | MI | Practitioner - Physician Assistant | 2466683420 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601003551 | MI | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Medical Center of Michigan,Inc | Current |
Accepting new patients | |
| Family Medical Center of Michigan, Inc | Current |
Accepting new patients | |
| Family Medical Center of Michigan, Inc | Past | Accepting new patients | |
| Family Medical Center of Michigan,Inc | Past | Accepting new patients |
Locations
130 Medical Center Dr
Carleton, MI 48117
1085 N Macomb St
#O
Monroe, MI 48162
Phone (734) 639-2546
8765 Lewis Ave
Temperance, MI 48182
2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5601003551 | MI | Yes |
Addresses
Primary practice location
130 Medical Center Dr
Carleton, MI 48117-9461
Mailing address
130 Medical Center Dr
Carleton, MI 48117-9461
Phone (734) 654-2169
Other providers in Carleton, MI
- Adil Sarosh
- Deantha Dawn Schuman
- Crystal Ann Shagena
- Jessica Lynne Sharon
- Shorelight Home Care LLC
- Christine M Stanford
- Addison Sweany
- Shirley Renee Urso-Farmer
- Vasquez Counseling and Wellness, PLLC
- Vivian Rose Vasquez
All providers in Carleton, MI · Medical Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.