NPIMap

Individual provider Active NPI

Kimberly K Provoast, PA

  • Physician Assistant
  • West Branch, MI
National Provider Identifier
1770899551
Registry record updated Oct 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005840 Issued in MI
Practice address
337 E Houghton Ave
West Branch, MI 48661-1127
Phone
(989) 345-5240
Fax
(989) 345-4513
NPI assigned
Aug 31, 2010
Last updated
Oct 18, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2012

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 5601005840 MI Primary

Addresses

Primary practice location

337 E Houghton Ave
West Branch, MI 48661-1127

Mailing address

337 E Houghton Ave
West Branch, MI 48661-1127
Phone (989) 345-5240

Other identifiers 2

IdentifierTypeStateIssuer
1629110556OtherMIGROUP NPI
5601005840OtherMIMI LICENSE NUMBER

Other names 1

  • Miss Kimberly K Rosebrugh Former name

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
I20110407000241 MI Practitioner - Physician Assistant 4981888476 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLaren Central MichiganGroup PAC ID 6103733092, 183 clinicians
Progress Physical Therapy IncGroup PAC ID 5698669919, 23 clinicians

Practice addresses (Care Compare)

1221 S Dr
Mount Pleasant, MI 48858-3257
Phone (989) 772-6811

2110 S M
West Branch, MI 48661-8821

3076 Northridge Rd
Hale, MI 48739-9277
Phone (989) 728-0242

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Central Michigan CurrentSince Sep 1, 2020 Accepting new patients
McLaren Central Michigan CurrentSince Sep 1, 2020 Accepting new patients
McLaren Central Michigan Past Accepting new patients

Locations

1221 South Dr
Mt Pleasant, MI 48858
Phone (989) 772-6700

2110 S M 76
Ste 6
West Branch, MI 48661
Phone (989) 345-1184

Organizations & group practices 5

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 7

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": "1283212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350518400000",
    "number": "1770899551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "337 E HOUGHTON AVE",
            "city": "WEST BRANCH",
            "state": "MI",
            "postal_code": "486611127",
            "telephone_number": "989-345-5240",
            "fax_number": "989-345-4513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "337 E HOUGHTON AVE",
            "city": "WEST BRANCH",
            "state": "MI",
            "postal_code": "486611127",
            "telephone_number": "989-345-5240",
            "fax_number": "989-345-4513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVOAST",
        "first_name": "KIMBERLY",
        "middle_name": "K",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-31",
        "last_updated": "2012-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1629110556",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI LICENSE NUMBER",
            "identifier": "5601005840",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "ROSEBRUGH",
            "middle_name": "K",
            "prefix": "MISS",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in West Branch, MI

Sources for this page

Verify at the official NPI Registry.