Individual provider Active NPI

Shawn M Bahleda

  • Physician Assistant
  • Gaylord, MI
National Provider Identifier
1598073801
Registry record updated Dec 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005821 Issued in MI
Practice address
829 N Center Ave
Gaylord, MI 49735-1595
Phone
(989) 731-7860
Fax
(989) 731-7833
NPI assigned
Sep 21, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2020

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 5601005821 MI Primary

Addresses

Primary practice location

829 N Center Ave
Gaylord, MI 49735-1595

Mailing address

850 N Otsego Ave
Suite 1
Gaylord, MI 49735-1568
Phone (989) 731-7708

Other identifiers 1

IdentifierTypeStateIssuer
OF96004OtherMIMEDICARE GROUP PTAN

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address shawn.bahleda@omhmedicalgroup.directbygreenway.com
Direct Messaging Address direct@direct.bronsonhg.org Direct Bronson Healthcare Group

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
I20101027000411 MI Practitioner - Physician Assistant 1254525991 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bronson Battle Creek HospitalGroup PAC ID 0547173478, 187 clinicians
Bronson Lakeview HospitalGroup PAC ID 9032008495, 72 clinicians
Bronson Methodist HospitalGroup PAC ID 0244148633, shared by 3 NPIs, 721 clinicians

Practice addresses (Care Compare)

2900 Watkins Rd
Battle Creek, MI 49015-8604
Phone (269) 979-6888

300 N Ave
Battle Creek, MI 49017-3307

300 N Ave Outpatient Ctr 2ND FL
Bronson Neuroscience Center
Battle Creek, MI 49017-3307
Phone (269) 245-5862

520 Railroad St
Bangor, MI 49013-1490
Phone (269) 427-5811

5623 Gull Rd
Kalamazoo, MI 49048-1098
Phone (269) 775-8031

601 John St
Kalamazoo, MI 49007-5377

6210 W Main St
Kalamazoo, MI 49009-8925
Phone (269) 286-7030

6220 W Main St
Kalamazoo, MI 49009-8925
Phone (269) 276-4744

930 Blue Star Hwy
South Haven, MI 49090-7758
Phone (269) 637-1115

Hospital & facility affiliations

  • Bronson Methodist Hospital Hospital, Kalamazoo, MI, CCN 230017
  • Bronson Battle Creek Hospital Hospital, Battle Creek, MI, CCN 230075
  • Bronson Lakeview Hospital Hospital, Paw Paw, MI, CCN 231332
  • Bronson South Haven Hospital Hospital, South Haven, MI, CCN 230085

Merit-based Incentive Payment System (MIPS)

Final score
86.43 of 100Reported as group
Quality
75.38
Promoting interoperability
100
Improvement activities
40
Cost
79.38

Merit-based Incentive Payment System (MIPS)

Final score
87.91 of 100Reported as group
Quality
83.03
Promoting interoperability
100
Improvement activities
40
Cost
76.65

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601005821MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bronson South Haven Hospital CurrentSince Feb 15, 2021 Accepting new patients
Bronson Methodist Hospital Physician Assistant CurrentSince Feb 15, 2021 Accepting new patients
Bronson Lakeview Hospital CurrentSince Feb 15, 2021 Accepting new patients
Bronson Battle Creek Hospital Physician Assistant CurrentSince Feb 15, 2021 Accepting new patients
Bronson Methodist Hospital Physician Assistant CurrentSince Feb 15, 2021 Accepting new patients
Bronson South Haven Hospital CurrentSince Feb 15, 2021 Accepting new patients
Bronson Lakeview Hospital CurrentSince Feb 15, 2021 Accepting new patients

Locations

300 North Ave
Fl 2
Battle Creek, MI 49017
Phone (269) 245-5862

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

6220 W Main St
Kalamazoo, MI 49009
Phone (269) 276-4744

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

451 Health Pkwy
Paw Paw, MI 49079
Phone (269) 655-1725

950 S Bailey Ave
South Haven, MI 49090
Phone (269) 639-2796

13320 N Boulevard St
Vicksburg, MI 49097
Phone (269) 649-2012

Interoperability endpoints

  • Direct secure messaging: direct@direct.bronsonhg.org

Organizations & group practices 7

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 4

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": "1285027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1598073801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 N OTSEGO AVE",
            "address_2": "SUITE 1",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351568",
            "telephone_number": "989-731-7708",
            "fax_number": "989-731-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 N CENTER AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351595",
            "telephone_number": "989-731-7860",
            "fax_number": "989-731-7833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAHLEDA",
        "first_name": "SHAWN",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-21",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "OF96004",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shawn.bahleda@omhmedicalgroup.directbygreenway.com",
            "affiliation": "N",
            "address_1": "829 N Center Ave",
            "city": "Gaylord",
            "state": "MI",
            "country_code": "US",
            "postal_code": "497351595",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "affiliationName": "Bronson Healthcare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gaylord, MI

Sources for this page

Verify at the official NPI Registry.