NPIMap

Individual provider Active NPI

Angela Michelle Hannah, PA-C

  • Physician Assistant
  • Hesperia, MI
National Provider Identifier
1679908552
Registry record updated Mar 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601006764 Issued in MI
Practice address
78 N Division St
Hesperia, MI 49421-5100
Phone
(231) 854-6415
Fax
(231) 854-6975
NPI assigned
Sep 10, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2022

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 5601006764 MI Primary

Addresses

Primary practice location

78 N Division St
Hesperia, MI 49421-5100

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560

Other names 1

  • Angela Michelle Derrick Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131231001117 MI Practitioner - Physician Assistant 7719115419 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Medical Center of West Michigan 62 clinicians
Spectrum Health Primary Care Partners 2,283 clinicians

Practice addresses (Care Compare)

1 Atkinson Dr
Ludington, MI 49431-1906
Phone (231) 843-2591

2900 Bradford St NE
Corewell Health Medical Group West
Grand Rapids, MI 49525-6427
Phone (616) 885-5000

2902 Bradford St NE
Corewell Health Medical Group West
Grand Rapids, MI 49525-6427
Phone (616) 486-6577

4444 Kalamazoo Ave SE
200 Corewell Health Medical Group West
Kentwood, MI 49508-4600
Phone (616) 391-5600

Hospital & facility affiliations

  • Corewell Health Gerber Hospital Hospital, Fremont, MI, CCN 231338
  • Corewell Health Ludington Hospital Hospital, Ludington, MI, CCN 230110
  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Medical Center of West Michigan CurrentSince Jun 28, 2019 Accepting new patients
Spectrum Health Primary Care Partners Current Accepting new patients
Memorial Medical Center of West Michigan CurrentSince Jun 28, 2019 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Apr 10, 2020 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Apr 10, 2020 Accepting new patients

Locations

212 S Sullivan Ave
Fremont, MI 49412
Phone (231) 924-1212

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

1 Atkinson Dr
Ludington, MI 49431
Phone (231) 843-2591

Interoperability endpoints

  • Direct secure messaging: ahannah101129@epic00.corewelldirect.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 4

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": "1378771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1679908552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 N DIVISION ST",
            "city": "HESPERIA",
            "state": "MI",
            "postal_code": "494215100",
            "telephone_number": "231-854-6415",
            "fax_number": "231-854-6975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNAH",
        "first_name": "ANGELA",
        "middle_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-10",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "DERRICK",
            "middle_name": "MICHELLE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hesperia, MI

Sources for this page

Verify at the official NPI Registry.