NPIMap

Individual provider Active NPI

Andrea Rose Koerner, PA

  • Physician Assistant
  • East Lansing, MI
National Provider Identifier
1689236002
Registry record updated May 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601010497 Issued in MI
Practice address
1650 Ramblewood Dr
East Lansing, MI 48823-7396
Phone
(517) 332-1200
NPI assigned
Jul 5, 2019
Last updated
May 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 5601010497 MI Primary

Addresses

Primary practice location

1650 Ramblewood Dr
East Lansing, MI 48823-7396

Mailing address

1180 E Twinbrook Dr
Dewitt, MI 48820-8319
Phone (989) 640-5513

Other names 1

  • Andrea Thelen 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
I20210818000997 MI Practitioner - Physician Assistant 4789915356 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Troy Gastroenterology PCGroup PAC ID 9739143991, 47 clinicians

Practice addresses (Care Compare)

1035 Charlevoix Dr
Grand Ledge, MI 48837-2223
Phone (517) 332-1200

1650 Ramblewood Dr
Suite 100
East Lansing, MI 48823-7396
Phone (517) 332-1200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601010497MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Troy Gastroenterology, PC CurrentSince Jul 8, 2021 Accepting new patients
Pinnacle Anesthesia PLLC Past Accepting new patients

Locations

1650 Ramblewood Dr
East Lansing, MI 48823
Phone 5173321200 ext. 248

1650 Ramblewood Dr
Ste 100
East Lansing, MI 48823

1650 Ramblewood Dr
Ste 200
East Lansing, MI 48823
Phone (517) 332-0200

1707 Lake Lansing Rd
Lansing, MI 48912
Phone (517) 267-0033

50438 Van Dyke Ave
Shelby Township, MI 48317
Phone (586) 726-8423

Organizations & group practices 3

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 8

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": "1562284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622160000000",
    "number": "1689236002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 E TWINBROOK DR",
            "city": "DEWITT",
            "state": "MI",
            "postal_code": "488208319",
            "telephone_number": "989-640-5513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 RAMBLEWOOD DR",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488237396",
            "telephone_number": "517-332-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOERNER",
        "first_name": "ANDREA",
        "middle_name": "ROSE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-05",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "THELEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in East Lansing, MI

Sources for this page

Verify at the official NPI Registry.