Eric James Dettloff, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601008640 Issued in MI

Practice address

1400 Mercy Dr Ste 100
Muskegon, MI 49444-1833

Phone

(231) 733-1326

Fax

(231) 733-5212

NPI assigned

Nov 23, 2016

Sex

Male

Sole proprietor

No

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

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopaedic Associates of Muskegon PCGroup PAC ID 7214908045, 113 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trinity Health Muskegon Hospital Hospital, Muskegon, MI, CCN 230066
• Mercy Health Saint Mary'S Hospital, Grand Rapids, MI, CCN 230059
• Trinity Health Grand Haven Hospital Hospital, Grand Haven, MI, CCN 230174

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: eric.dettloff.1@29636.direct.athenahealth.com

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.

• Orthopaedic Associates of Muskegon, PC

  • Orthopaedic Surgery Physician
  • Muskegon, MI
  • NPI 1972566594
  Medicare reassignment Care Compare group NPD
• Spectrum Health Primary Care Partners

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1235188673
  Medicare reassignment NPD
• Spectrum Health Primary Care Partners

  • Nurse Practitioner
  • Grand Rapids, MI
  • NPI 1346480258
  NPD
• Spectrum Health Primary Care Partners

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1689499667
  NPD
• Grant Medical Center

  • Family Medicine Physician
  • Grant, MI
  • NPI 1437272689
  NPD (past)
• R. Joseph Grierson, D.O., PLC

  • Orthopaedic Surgery Physician
  • Ludington, MI
  • NPI 1366677783
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Health Partners

  • General Acute Care Hospital
  • Muskegon, MI
  • NPI 1831132133
  Care Compare affiliation
• Saint Mary'S Health Services

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1639111057
  Care Compare affiliation
• Trinity Health Grand Haven Hospital

  • General Acute Care Hospital
  • Grand Haven, MI
  • NPI 1942379284
  Care Compare affiliation

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

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723161600000",
    "number": "1679016638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 MERCY DR STE 100",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441833",
            "telephone_number": "231-733-1326",
            "fax_number": "231-733-5212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MERCY DR STE 100",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441833",
            "telephone_number": "231-733-1326",
            "fax_number": "231-733-5212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4100 Lake Dr SE Ste 300",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495468292",
            "country_code": "US",
            "telephone_number": "616-267-8860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DETTLOFF",
        "first_name": "ERIC",
        "middle_name": "JAMES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-23",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Impressions, PLC
• Laree C Depies, CRNA
• Hailey Depouw
• Dennis Vincent Desimone, DO
• Frederick Michael Detorres, M.D.
• Kirsten Avery Deuel
• Patricia J Deur, LMSW
• Brenda Deveau
• Nancy Claire Devine, M.D.
• Gabriel Angelo Devivo, DO

• Physician Assistant in Muskegon, MI
• Providers in Muskegon, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.