NPIMap

Individual provider Active NPI

Mollie Anne Tisdale, PAC

  • Physician Assistant
  • Big Rapids, MI
National Provider Identifier
1750014296
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601011275 Issued in MI
Practice address
14755 215TH Ave
Big Rapids, MI 49307-9224
Phone
(231) 796-3200
NPI assigned
Jul 1, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601011275 MI Primary

Addresses

Primary practice location

14755 215TH Ave
Big Rapids, MI 49307-9224

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Other names 1

  • Mollie Anne Tuthill Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mtisdale2519277@epic00.corewelldirect.org
FHIR URL https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/

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
I20221107002404 MI Practitioner - Physician Assistant 4789051616 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mecosta County Medical CenterGroup PAC ID 1951215540, 53 clinicians

Practice addresses (Care Compare)

14755 215TH Ave
Big Rapids, MI 49307-9224
Phone (231) 796-3200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Reed City Hospital Corporation CurrentSince May 31, 2024 Accepting new patients
Mecosta County Medical Center CurrentSince May 31, 2024 Accepting new patients
Mecosta County Medical Center CurrentSince May 31, 2024 Accepting new patients
Reed City Hospital Corporation CurrentSince May 31, 2024 Accepting new patients
Spectrum Health United CurrentSince May 31, 2024 Accepting new patients
Lansing Urgent Care, PLC PastSince Oct 1, 2022 Accepting new patients

Locations

1227 W State St
Belding, MI 48809
Phone (616) 794-0800

14755 215th Ave
Big Rapids, MI 49307
Phone (231) 796-3200

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

Organizations & group practices 6

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": "1656633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1750014296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14755 215TH AVE",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493079224",
            "telephone_number": "231-796-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISDALE",
        "first_name": "MOLLIE",
        "middle_name": "ANNE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-01",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mtisdale2519277@epic00.corewelldirect.org",
            "affiliation": "N",
            "address_1": "14755 215th Ave",
            "city": "Big Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "493079224",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "14755 215th Ave",
            "city": "Big Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "493079224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MOLLIE",
            "last_name": "TUTHILL",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Big Rapids, MI

Sources for this page

Verify at the official NPI Registry.