Kristen Nicole Gilley, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601010969 Issued in MI

Practice address

4294 Laurel Dr
Lake Odessa, MI 48849-8430

Phone

(616) 374-7660

NPI assigned

Apr 7, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kristen Nicole Cody Former name

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

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pennock HospitalGroup PAC ID 4587551015, 79 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Corewell Health Pennock Hospital Hospital, Hastings, MI, CCN 231339

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kgilley178097@epic00.corewelldirect.org

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.

• Pennock Hospital

  • Family Medicine Physician
  • Hastings, MI
  • NPI 1518186295
  Medicare reassignment Care Compare group NPD
• Pennock Hospital

  • Internal Medicine Physician
  • Hastings, MI
  • NPI 1750500435
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1760124176",
    "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",
            "telephone_number": "616-486-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4294 LAUREL DR",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "488498430",
            "telephone_number": "616-374-7660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLEY",
        "first_name": "KRISTEN",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-07",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "CODY",
            "middle_name": "NICOLE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Lyn Fletcher
• Katlyn Franke, MD
• Aaron Blane Freeman, D.D.S
• Gerald T Licari DDS PC
• Deb Giaseman
• Catherine Hemingway, R.D.H
• John P. Hemming, O.D.
• Chad Ronald Hickey, D.C.
• Jordan Christian Counseling
• Linda L. Kimmel, MA, LPC

• Physician Assistant in Lake Odessa, MI
• Providers in Lake Odessa, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.