Katelyn Marie Bergeron, PA-C
Individual provider Active NPI Physician Assistant · Brighton, MI
NPI 1710244405 · NPPES record last updated Jun 27, 2019
Key facts
- NPI
- 1710244405
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601006363 (MI)
- Practice address
- 8001 Challis Rd
Brighton, MI 48116-7446 - Phone
- (810) 227-9510
- NPI assigned
- Apr 18, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Regents of the University of Michigan
Practice addresses (Care Compare)
8001 Challis Rd
Brighton, MI 48116-7446
Phone (810) 227-9510
Hospital & facility affiliations
- University of Michigan Health System
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 |
|---|---|---|---|---|
| I20120809000678 | MI | Practitioner - Physician Assistant | 0749436509 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601006363 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the University of Michigan | Physician Assistant | Current |
Accepting new patients |
| Regents of the University of Michigan | Current |
Accepting new patients | |
| Regents of the University of Michigan | Physician Assistant | Current | Accepting new patients |
Locations
1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280
1801 Briarwood Cir
Ann Arbor, MI 48108
Phone (734) 539-5000
3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229
1500 E Medical Center Dr
Fl 2
Ann Arbor, MI 48109
Phone (734) 936-5738
8001 Challis Rd
Brighton, MI 48116
Phone (810) 227-9510
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | |||
| Physician Assistant | 363A00000X | 5601006363 | MI | Yes |
Addresses
Primary practice location
8001 Challis Rd
Brighton, MI 48116-7446
Mailing address
3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299
Other names
- Katelyn Malo
Other providers in Brighton, MI
- Christine Bell
- Mary Beth Benedict
- Michelle A. Benedict
- Mariel Rosati Benjamin
- Karen Joan Bergbower
- Paula Berlin
- Beth Michelle Berman
- Steven Howard Bernier
- Caitlin Lauren Bernstein
- Michael Joseph Berry
All providers in Brighton, MI · 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 Jun 27, 2019. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.