Audrey Macciomei

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601012216 Issued in MI

Practice address

630 Kenmoor Ave SE Ste 103
Grand Rapids, MI 49546-8626

Phone

(616) 600-4950

NPI assigned

May 7, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: audrey.macciomei.1@20679.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/20679/brand/1/csg/1/fhir/r4

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.

• Womens Health Collective

  • Gynecology Physician
  • Grand Rapids, MI
  • NPI 1629615646
  NPD (past)

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

{
    "created_epoch": "1715040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1639927593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 HELEN ST NE UNIT 1",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495033670",
            "telephone_number": "331-999-5493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 KENMOOR AVE SE STE 103",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468626",
            "telephone_number": "616-600-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACCIOMEI",
        "first_name": "AUDREY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-07",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caleb R Maatman, PA
• Thomas J Maatman, D.O.
• Kayley Marie Mabie
• Robin Gay Mac Donald, PT
• Rachel Macak, MD
• Claire Eloise Macdonald
• Dawn Marie Macdonald, LLMSW
• Erin Macdonald
• Kimberly Anne Macdonald, PA-C
• Krista K. Macdonald, PA-C

• Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.