Individual provider Active NPI

Paul James Tarvis

  • Student in an Organized Health Care Education/Training Program
  • Pinckney, MI
National Provider Identifier
1740022045
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
6439 Lazy K LN
Pinckney, MI 48169-8124
Phone
(810) 588-7671
NPI assigned
Jun 10, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

6439 Lazy K LN
Pinckney, MI 48169-8124

Mailing address

6439 Lazy K LN
Pinckney, MI 48169-8124
Phone (810) 588-7671

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240912003329 MI Practitioner - Physician Assistant 5092255349 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Joseph Mercy HospitalGroup PAC ID 3779489281, 69 clinicians

Practice addresses (Care Compare)

5301 E Huron River Dr
Ann Arbor, MI 48197-1051
Phone (734) 712-3456

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Joseph Mercy Hospital CurrentSince Sep 1, 2024 Accepting new patients
St Joseph Mercy Hospital CurrentSince Sep 1, 2024 Accepting new patients
St Joseph Mercy Hospital Past Accepting new patients

Locations

20555 Victor Pkwy
Livonia, MI 48152
Phone (734) 343-3925

5301 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-7246

Interoperability endpoints

  • Direct secure messaging: ptarvis669813@direct.trinity-health.org

Organizations & group practices 4

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.

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": "1717977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1740022045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6439 LAZY K LN",
            "city": "PINCKNEY",
            "state": "MI",
            "postal_code": "481698124",
            "telephone_number": "810-588-7671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6439 LAZY K LN",
            "city": "PINCKNEY",
            "state": "MI",
            "postal_code": "481698124",
            "telephone_number": "810-588-7671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARVIS",
        "first_name": "PAUL",
        "middle_name": "JAMES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinckney, MI

Sources for this page

Verify at the official NPI Registry.