Individual provider Active NPI

Shelby Novetsky, PA-C

  • Physician Assistant
  • Kalamazoo, MI
National Provider Identifier
1669258828
Registry record updated Sep 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601011862 Issued in MI
Practice address
1541 Gull Rd Ste 210
Kalamazoo, MI 49048-1644
Phone
(269) 343-1264
Fax
(269) 552-0300
NPI assigned
Sep 5, 2023
Last updated
Sep 30, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2026

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 5601011862 MI Primary

Addresses

Primary practice location

1541 Gull Rd Ste 210
Kalamazoo, MI 49048-1644

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (269) 552-2823

Other practice location 1

5973 Beatrice Dr
Kalamazoo, MI 49009-9583
Phone (269) 286-7110

Other identifiers 1

IdentifierTypeStateIssuer
1669258828MedicaidMI

Other names 1

  • Shelby Suseland Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct Bronson Healthcare Group

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
I20231101003213 MI Practitioner - Physician Assistant 9638525231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bronson Methodist HospitalGroup PAC ID 0244148633, 721 clinicians

Practice addresses (Care Compare)

601 John St
Kalamazoo, MI 49007-5377

6210 W Main St
Kalamazoo, MI 49009-8925
Phone (269) 286-7030

6220 W Main St
Aec Clinic
Kalamazoo, MI 49009-8925
Phone (269) 276-4744

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601011862MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bronson Methodist Hospital Physician Assistant CurrentSince Dec 4, 2023 Accepting new patients

Locations

5973 Beatrice Dr
Kalamazoo, MI 49009
Phone (269) 286-7110

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

601 John St
#42
Kalamazoo, MI 49007
Phone (269) 341-7806

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

Interoperability endpoints

  • Direct secure messaging: direct@direct.bronsonhg.org

Organizations & group practices 1

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 2

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": "1693872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790726400000",
    "number": "1669258828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380",
            "telephone_number": "269-552-2823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 GULL RD STE 210",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481644",
            "telephone_number": "269-343-1264",
            "fax_number": "269-552-0300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5973 Beatrice Dr",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490099583",
            "country_code": "US",
            "telephone_number": "269-286-7110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOVETSKY",
        "first_name": "SHELBY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-05",
        "last_updated": "2026-09-30",
        "certification_date": "2026-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669258828",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "affiliationName": "Bronson Healthcare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHELBY",
            "last_name": "SUSELAND",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.