Individual provider Active NPI

Courtney N Taylor, PA-C

  • Physician Assistant
  • Ann Arbor, MI
National Provider Identifier
1639387798
Registry record updated Jun 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601008922 Issued in MI
Practice address
4350 Jackson Rd Ste 200
Ann Arbor, MI 48103-1889
Phone
(734) 761-2581
Fax
(734) 761-9540
NPI assigned
May 20, 2007
Last updated
Jun 6, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601008922 MI Primary
Medical Physician Assistant 363AM0700X 004237 GA

Addresses

Primary practice location

4350 Jackson Rd Ste 200
Ann Arbor, MI 48103-1889

Mailing address

24 Frank Lloyd Wright Dr Lbby J2000
Ann Arbor, MI 48105-9484
Phone (734) 747-6766

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
I20190415002226 MI Practitioner - Physician Assistant 8628056199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

128 Van Buren St
Chelsea, MI 48118-1623
Phone (734) 475-8677

3200 W Liberty Rd
Suite C
Ann Arbor, MI 48103-9794
Phone (734) 761-2581

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601008922MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Services Corporation Physician Assistant CurrentSince Jun 1, 2019 Accepting new patients
Iha Health Service Corporation CurrentSince Jun 1, 2019 Accepting new patients
Emory Specialty Associates, LLC Past Accepting new patients
Iha Health Services Corporation Past Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

3200 W Liberty Rd
Ste C
Ann Arbor, MI 48103
Phone (734) 761-2581

4350 Jackson Rd
Ste 200
Ann Arbor, MI 48103
Phone (734) 761-2581

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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": "1179619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559779200000",
    "number": "1639387798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR LBBY J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059484",
            "telephone_number": "734-747-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 JACKSON RD STE 200",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481031889",
            "telephone_number": "734-761-2581",
            "fax_number": "734-761-9540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "COURTNEY",
        "middle_name": "N",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-20",
        "last_updated": "2019-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008922",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004237",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.