NPIMap

Individual provider Active NPI

Grant Fons, PA

  • Physician Assistant
  • Redford, MI
National Provider Identifier
1619647989
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601010238 Issued in MI
Practice address
14671 Telegraph Rd
Redford, MI 48239-3300
Phone
(313) 948-3055
NPI assigned
Sep 17, 2021
Last updated
Sep 17, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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 5601010238 MI Primary

Addresses

Primary practice location

14671 Telegraph Rd
Redford, MI 48239-3300

Mailing address

14671 Telegraph Rd
Redford, MI 48239-3300
Phone (313) 948-3055

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
I20210923000309 MI Practitioner - Physician Assistant 0648677351 Reassigns benefits to 13 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLaren Thumb RegionGroup PAC ID 6800709221, 39 clinicians

Practice addresses (Care Compare)

1100 S Van Dyke
Bad Axe, MI 48413-9615

1100 S Van Dyke Rd
Bad Axe, MI 48413-9615
Phone (989) 269-9521

1117 S Van Dyke Rd
Suite 200
Bad Axe, MI 48413-8467
Phone (989) 269-2597

6 N Main St
Elkton, MI 48731-5137
Phone (989) 375-2273

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601010238MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Taylor Urgent Care PC CurrentSince Sep 1, 2021 Accepting new patients
McLaren Thumb Region CurrentSince Mar 9, 2023 Accepting new patients
Huron Pathology Services PC Current Accepting new patients
McLaren Thumb Region Current Accepting new patients
McLaren Thumb Region CurrentSince Mar 9, 2023 Accepting new patients
Farmington Hills Urgent Care Walk-in Clinic PC PastSince Jul 31, 2022 Accepting new patients

Locations

1060 S Van Dyke Rd
Ste 600700
Bad Axe, MI 48413

1100 S Van Dyke Rd
Bad Axe, MI 48413
Phone (989) 269-9521

1117 S Van Dyke Rd
Ste 200
Bad Axe, MI 48413
Phone (989) 269-2597

23234 Ecorse Rd
Taylor, MI 48180
Phone (313) 292-8400

Organizations & group practices 17

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 17

Hospital & facility affiliations 12

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": "1631836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1619647989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14671 TELEGRAPH RD",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482393300",
            "telephone_number": "313-948-3055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14671 TELEGRAPH RD",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482393300",
            "telephone_number": "313-948-3055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONS",
        "first_name": "GRANT",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redford, MI

Sources for this page

Verify at the official NPI Registry.