Individual provider Active NPI

Andrea Macintosh

  • Physician Assistant
  • Muskegon, MI
National Provider Identifier
1649749136
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601009618 Issued in MI
Practice address
376 E Apple Ave
Muskegon, MI 49442-3466
Phone
(231) 724-3626
NPI assigned
Nov 14, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 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 5601009618 MI Primary

Addresses

Primary practice location

376 E Apple Ave
Muskegon, MI 49442-3466

Mailing address

376 E Apple Ave
Muskegon, MI 49442-3466
Phone (231) 724-3626

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
I20191011000856 MI Practitioner - Physician Assistant 8921339565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of MuskegonGroup PAC ID 2264325448, 32 clinicians

Practice addresses (Care Compare)

376 E Apple Ave
Muskegon, MI 49442-3466
Phone (231) 724-1111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
County of Muskegon CurrentSince Sep 3, 2019 Accepting new patients

Locations

376 E Apple Ave
Muskegon, MI 49442
Phone (231) 724-3699

Organizations & group practices 2

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 1

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": "1542153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580342400000",
    "number": "1649749136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "376 E APPLE AVE",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494423466",
            "telephone_number": "231-724-3626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "376 E APPLE AVE",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494423466",
            "telephone_number": "231-724-3626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACINTOSH",
        "first_name": "ANDREA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-14",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601009618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

Verify at the official NPI Registry.