Individual provider Active NPI

Shannon Aileen McCarthy, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1639521354
Registry record updated Feb 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601011545
Practice address
235 Wealthy St SE
Grand Rapids, MI 49503-5247
Phone
(616) 840-8000
Fax
(616) 840-9642
NPI assigned
Jul 6, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2025

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 5601011545 Primary

Addresses

Primary practice location

235 Wealthy St SE
Grand Rapids, MI 49503-5247

Mailing address

235 Wealthy St SE
Grand Rapids, MI 49503-5247
Phone (616) 840-8000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address smccarthy167671@direct.covenanthealthcare.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160907000488 IL Practitioner - Physician Assistant 0244526952 Reassigns benefits to 1 organization
I20230601002370 MI Practitioner - Physician Assistant 0244526952 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

235 Wealthy St SE
Grand Rapids, MI 49503-5247
Phone (616) 242-0422

235 Wealthy St SE FL
5 Mary Free Bed Skilled Nursing
Grand Rapids, MI 49503-5247
Phone (616) 840-8162

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rush University Medical Center CurrentSince Oct 1, 2020 Accepting new patients
Mary Free Bed Rehabiltation Hospital CurrentSince Sep 23, 2024 Accepting new patients
Rush University Medical Group CurrentSince Oct 1, 2020 Accepting new patients
Mary Free Bed Rehabilitation Hospital Past Accepting new patients

Locations

75 Remittance Dr
Dept 1611
Chicago, IL 60675

1725 W Harrison St
Ste 1010
Chicago, IL 60612
Phone (312) 942-5904

600 S Paulina St
Ste 140
Chicago, IL 60612
Phone (312) 942-5865

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

430 Warrenville Rd
Ste 2
Lisle, IL 60532
Phone (630) 724-8700

235 Wealthy St SE
Grand Rapids, MI 49503
Phone (616) 242-0422

Interoperability endpoints

  • Direct secure messaging: smccarthy85173@direct.rush.rush-health.com

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1639521354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 WEALTHY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035247",
            "telephone_number": "616-840-8000",
            "fax_number": "616-840-9642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 WEALTHY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035247",
            "telephone_number": "616-840-8000",
            "fax_number": "616-840-9642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCARTHY",
        "first_name": "SHANNON",
        "middle_name": "AILEEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-06",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": "5601011545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smccarthy167671@direct.covenanthealthcare.com",
            "affiliation": "N",
            "address_1": "235 Wealthy St SE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495035247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.