NPIMap

Individual provider Active NPI

Justin L Shields, PA

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1730471368
Registry record updated Oct 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601006017 Issued in MI
Practice address
25 Michigan St NE Ste 5100
Grand Rapids, MI 49503-2572
Phone
(616) 267-0800
Fax
(616) 267-0801
NPI assigned
May 16, 2011
Last updated
Oct 9, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 9, 2015

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 5601006017 MI Primary
Federally Qualified Health Center (FQHC) 261QF0400X

Addresses

Primary practice location

25 Michigan St NE Ste 5100
Grand Rapids, MI 49503-2572

Mailing address

100 Michigan St NE MC-845
Grand Rapids, MI 49503-2560
Phone (616) 267-0800

Other identifiers 1

IdentifierTypeStateIssuer
1730471368MedicaidMI

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
I20110606000332 MI Practitioner - Physician Assistant 1557548203 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Specialty ServicesGroup PAC ID 2365439544, 87 clinicians

Practice addresses (Care Compare)

1500 E Sherman Blvd
Muskegon, MI 49444-1849
Phone (231) 672-3883

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601006017MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Hospitals CurrentSince Oct 19, 2015 Accepting new patients
Mercy Physician Network Physician Assistant CurrentSince Apr 29, 2018 Accepting new patients
Spectrum Health Hospitals CurrentSince Oct 19, 2015 Accepting new patients

Locations

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

25 Michigan St NE
Ste 2100
Grand Rapids, MI 49503
Phone (616) 391-3777

25 Michigan St NE
Ste 5100
Grand Rapids, MI 49503
Phone (616) 267-0800

2006 Holton Rd
North Muskegon, MI 49445
Phone (231) 672-3333

Interoperability endpoints

  • Direct secure messaging: jshields36650@direct.trinity-health.org

Organizations & group practices 8

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 1

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": "1305504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444348800000",
    "number": "1730471368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE MC-845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-267-0800",
            "fax_number": "616-267-0801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MICHIGAN ST NE STE 5100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032572",
            "telephone_number": "616-267-0800",
            "fax_number": "616-267-0801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "JUSTIN",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-16",
        "last_updated": "2015-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006017",
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730471368",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.