Individual provider Active NPI

Megan Carson, P.A.

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1679631816
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1501 S California Ave
Chicago, IL 60608-1732
Phone
(773) 257-6770
NPI assigned
Dec 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 IL Primary

Addresses

Primary practice location

1501 S California Ave
Chicago, IL 60608-1732

Mailing address

1501 S California Ave
Chicago, IL 60608-1732
Phone (773) 257-6770

Other names 1

  • Megan Thiele Former name

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
I20080829000160 MI Practitioner - Physician Assistant 5597770651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cherry Street Services IncGroup PAC ID 6800707647, 58 clinicians

Practice addresses (Care Compare)

550 Cherry St SE
Grand Rapids, MI 49503-4748
Phone (616) 235-7272

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-002259ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cherry Street Services, Inc. CurrentSince May 20, 2019 Accepting new patients
Cherry Street Services, Inc CurrentSince May 20, 2019 Accepting new patients
Cherry Street Services, Inc. Past Accepting new patients
Cherry Street Health Services Past Accepting new patients

Locations

100 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 965-8209

2055 Rosewood Ave SE
Grand Rapids, MI 49506
Phone (616) 776-5110

550 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 235-7272

1800 Tremont Blvd NW
Grand Rapids, MI 49504
Phone (616) 791-6593

50 35th St SW
Grand Rapids, MI 49548
Phone (616) 776-5110

421 Fountain St NE
Grand Rapids, MI 49503
Phone (616) 776-5120

2135 Buchanan Ave SW
Grand Rapids, MI 49507
Phone (616) 247-3638

669 Stocking Ave NW
Grand Rapids, MI 49504
Phone (616) 235-1480

2929 Burlingame Ave SW
Wyoming, MI 49509
Phone (616) 965-8333

Interoperability endpoints

  • Direct secure messaging: megan.carson.p1@direct.cherryhealth.nextgenshare.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679631816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 S CALIFORNIA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081732",
            "telephone_number": "773-257-6770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 S CALIFORNIA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081732",
            "telephone_number": "773-257-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARSON",
        "first_name": "MEGAN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MEGAN",
            "last_name": "THIELE",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.