Individual provider Active NPI

Krista K. Macdonald, PA-C

  • Medical Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1669556783
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
085-003409 Issued in IL
Practice address
300 Lafayette Ave SE # 220
Grand Rapids, MI 49503-4692
Phone
(616) 685-5170
NPI assigned
Oct 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601007679 MI
Medical Physician Assistant 363AM0700X 085003409
Medical Physician Assistant 363AM0700X 085003409 IL
Medical Physician Assistant 363AM0700X 085-003409 IL Primary

Addresses

Primary practice location

300 Lafayette Ave SE # 220
Grand Rapids, MI 49503-4692

Mailing address

685 Pine Meadow LN NE
Ada, MI 49301-9773
Phone (630) 484-3910

Other practice location 1

300 68th St SE
Grand Rapids, MI 49548-6927
Phone (800) 678-5500

Other identifiers 1

IdentifierTypeStateIssuer
P00392993OtherKYRAILROAD MEDICARE

Other names 1

  • Krista Kay Rosseto Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address PineRestCMHS@directaddress.pinerest.org Direct

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
I20090226000329 IL Practitioner - Physician Assistant 0042316424 Reassigns benefits to 1 organization
I20210928000799 MI Practitioner - Physician Assistant 0042316424 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Kentucky College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10047 Crossroad CT SE
Caledonia, MI 49316-7316
Phone (616) 685-8850

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone (616) 685-5000

220 Cherry St SE
Grand Rapids, MI 49503-4608
Phone (616) 685-5050

250 Cherry St SE
Grand Rapids, MI 49503-4608
Phone (616) 685-5600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601007679MIMDPhysician Assistant
085-003409ILMDMedical Physician Assistant
TC054KYMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services CurrentSince Oct 14, 2021 Accepting new patients
Cepamerica Illinois LLP CurrentSince Oct 1, 2016 Accepting new patients
Cepamerica Illinois LLP CurrentSince Oct 1, 2016 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Oct 14, 2021 Accepting new patients
Advantage Health Saint Mary'S Medical Group Physician Assistant CurrentSince Nov 1, 2021 Accepting new patients
Advantage Health Saint Mary'S Medical Group Past Accepting new patients

Locations

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1325 N Highland Ave
Aurora, IL 60506
Phone (630) 801-2756

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

1425 N Randall Rd
Elgin, IL 60123
Phone (224) 783-5437

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

310 Lafayette Ave SE
Ste 220
Grand Rapids, MI 49503
Phone (616) 685-5170

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Interoperability endpoints

  • Direct secure messaging: krossetto1424367@direct.trinity-health.org

Organizations & group practices 8

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": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1669556783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 PINE MEADOW LN NE",
            "city": "ADA",
            "state": "MI",
            "postal_code": "493019773",
            "telephone_number": "630-484-3910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LAFAYETTE AVE SE # 220",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034692",
            "telephone_number": "616-685-5170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 68th St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495486927",
            "country_code": "US",
            "telephone_number": "800-678-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACDONALD",
        "first_name": "KRISTA",
        "middle_name": "K.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007679",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": "085003409",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085003409",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-003409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00392993",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "PineRestCMHS@directaddress.pinerest.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "300 68th St SE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495486927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KRISTA",
            "last_name": "ROSSETO",
            "middle_name": "KAY",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.