Individual provider Active NPI

Cassidy Ebach

  • Physician Assistant
  • Livonia, MI
National Provider Identifier
1649949082
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601010644 Issued in MI
Practice address
36622 Five Mile Rd
Livonia, MI 48154-1900
Phone
(734) 266-3349
NPI assigned
Sep 9, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 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 5601010644 MI Primary

Addresses

Primary practice location

36622 Five Mile Rd
Livonia, MI 48154-1900

Mailing address

22510 Moorgate St
Novi, MI 48374-3769
Phone (124) 892-4580

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
I20210924000277 MI Practitioner - Physician Assistant 1658778253 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mendelson Orthopedics PCGroup PAC ID 8426008368, 69 clinicians

Practice addresses (Care Compare)

35735 Mound Rd
Sterling Heights, MI 48310-4728

36622 5 Mile Rd
Livonia, MI 48154-1900
Phone (734) 542-0200

Hospital & facility affiliations

  • St Joe Mercy Hospital System Livonia Hospital, Livonia, MI, CCN 230002

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mendelson Orthopedics PC CurrentSince Sep 27, 2021 Accepting new patients
Mendelson Orthopedics PC CurrentSince Sep 27, 2021 Accepting new patients
Mendelson Orthopedics PC Past Accepting new patients

Locations

14555 Levan Rd
Ste 215
Livonia, MI 48154
Phone (734) 542-0200

36622 5 Mile Rd
Livonia, MI 48154
Phone (734) 542-0200

500 Stephenson Hwy
#300
Troy, MI 48083
Phone (586) 439-6258

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: cebach3751703@direct.trinity-health.org
  • Direct secure messaging: cebach1125921@direct.hfhs.org

Organizations & group practices 4

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": "1631145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1649949082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22510 MOORGATE ST",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483743769",
            "telephone_number": "124-892-4580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36622 FIVE MILE RD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481541900",
            "telephone_number": "734-266-3349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBACH",
        "first_name": "CASSIDY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-09",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

Verify at the official NPI Registry.