Individual provider Active NPI

Rebecca Rae Mahn, PA-C

  • Physician Assistant
  • Muskegon, MI
National Provider Identifier
1558836650
Registry record updated Oct 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601008867 Issued in MI
Practice address
1700 Clinton St
Muskegon, MI 49442-5502
Phone
(231) 728-4601
Fax
(231) 728-5777
NPI assigned
Oct 4, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2018

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 5601008867 MI Primary

Addresses

Primary practice location

1700 Clinton St
Muskegon, MI 49442-5502

Mailing address

6250 Heights Ravenna Rd
Fruitport, MI 49415-8697
Phone (231) 742-1983

Other names 1

  • Rebecca Rae Shineldecker 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
I20181206001369 MI Practitioner - Physician Assistant 5698019354 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Michigan Observation Services PLLCGroup PAC ID 3375938889, 30 clinicians

Practice addresses (Care Compare)

1500 E Sherman Blvd
Mercy Health
Muskegon, MI 49444-1849
Phone (231) 728-4601

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 2

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 1

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": "1538611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538611200000",
    "number": "1558836650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6250 HEIGHTS RAVENNA RD",
            "city": "FRUITPORT",
            "state": "MI",
            "postal_code": "494158697",
            "telephone_number": "231-742-1983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 CLINTON ST",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494425502",
            "telephone_number": "231-728-4601",
            "fax_number": "231-728-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHN",
        "first_name": "REBECCA",
        "middle_name": "RAE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-04",
        "last_updated": "2018-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "SHINELDECKER",
            "middle_name": "RAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Muskegon, MI

Sources for this page

Verify at the official NPI Registry.