Individual provider Active NPI

Kaitlyn Marie Zuccaro, PA

  • Physician Assistant
  • Royal Oak, MI
National Provider Identifier
1770239774
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601011205 Issued in MI
Practice address
3601 W 13 Mile Rd
Royal Oak, MI 48073-6712
Phone
(248) 898-1994
NPI assigned
Feb 28, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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 5601011205 MI Primary

Addresses

Primary practice location

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

Mailing address

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

Other practice location 1

100 Michigan St NE Ste 4297
Grand Rapids, MI 49503-2560
Phone (616) 267-7900

Other names 1

  • Kaitlyn Marie Solomon Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kzuccaro702794@epic00.corewelldirect.org

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
I20221005000585 MI Practitioner - Physician Assistant 7416333075 Reassigns benefits to 2 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
Beaumont Medical Group Hospital Based ServicesGroup PAC ID 3072875889, 575 clinicians

Practice addresses (Care Compare)

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

3601 W 13 Mile Rd Ec
Beaumont Emergency Services Ro
Royal Oak, MI 48073-6712
Phone (248) 898-0575

44201 Dequindre Rd
Troy, MI 48085-1117
Phone (248) 964-1187

44201 Dequindre Rd Ec
Beaumont Emergency Services TR
Troy, MI 48085-1117
Phone (248) 964-5111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601011205MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Medical Practices CurrentSince Nov 4, 2022 Accepting new patients

Locations

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

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

Interoperability endpoints

  • Direct secure messaging: kzuccaro702794@epic00.corewelldirect.org

Organizations & group practices 3

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 3

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": "1646006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1770239774",
    "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": "3601 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "248-898-1994"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Michigan St NE Ste 4297",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495032560",
            "country_code": "US",
            "telephone_number": "616-267-7900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZUCCARO",
        "first_name": "KAITLYN",
        "middle_name": "MARIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-28",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kzuccaro702794@epic00.corewelldirect.org",
            "affiliation": "N",
            "address_1": "3601 W 13 Mile Rd",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KAITLYN",
            "last_name": "SOLOMON",
            "middle_name": "MARIE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.