Summer Moffat Anderson, PA-C
Individual provider Active NPI Medical Physician Assistant · Birmingham, MI
NPI 1689328692 · NPPES record last updated Feb 10, 2023
Key facts
- NPI
- 1689328692
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 5601011036 (MI)
- Practice address
- 122 E Brown St
Birmingham, MI 48009-6201 - Phone
- (248) 731-2155
- NPI assigned
- Feb 8, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230215002847 | MI | Practitioner - Physician Assistant | 3375915515 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601011036 | MI | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry Ford Macomb Hospital Corporation | Past | Accepting new patients |
Interoperability endpoints
- summer.anderson.1@8250.direct.athenahealth.com
- summer.anderson.1@23489.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5601011036 | MI | Yes |
Addresses
Primary practice location
122 E Brown St
Birmingham, MI 48009-6201
Mailing address
43141 Woodward Ave
Bloomfield Hills, MI 48302-5005
Phone (248) 333-0333
Other practice location 1
1430 S Lapeer Rd
Lake Orion, MI 48360-1437
Phone (248) 693-0543
Other providers in Birmingham, MI
- Amazing Physical Therapy and Rehabilitation
- Amyna Ftouni
- Gretchen M Anderson
- Jonathon Henning Anderson
- Peter G Anderson
- Andrea Whedon-Hulbert D.C. PLLC
- Yen Ang
- Judith Antenucci
- Anthony B. Michaels, D.O., P.C.
- Carolyn Joanna Archer
All providers in Birmingham, MI · Medical Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.