Susanne Pettigrew, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601001592 Issued in MI

Practice address

145 Michigan St NE Ste 4400
Grand Rapids, MI 49503-2564

Phone

(616) 486-6333

NPI assigned

Aug 11, 2005

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2025 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: spettigrew6438@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.

• True Women's Clinic of Grand Rapids, PC

  • Medical Specialty Clinic/Center
  • Grand Rapids, MI
  • NPI 1629684386
  NPD (past)

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585526400000",
    "number": "1780686550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "985 GEZON PKWY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495099563",
            "telephone_number": "616-252-4655",
            "fax_number": "616-252-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 MICHIGAN ST NE STE 4400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032564",
            "telephone_number": "616-486-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIGREW",
        "first_name": "SUSANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-11",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601001592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Peter Petrovas, M.D.
• Amanda Petrovich
• Jerry Alvin Petrovich, MSW
• Breanna Marie Petrucciani, MS, RDN
• Lauren Petruska
• Erin Megan Pettijohn, M.D.
• Stuart Pettijohn, DDS
• Jayne Deur Pettinga, NURSE PRACTITIONER
• Matthew Scott Pettinga, MA, LPC
• Taylor Pettit-Rademaker, LMSW, CAADC

• Medical Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.