Michelle R Pellerin, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-575 Issued in ID

Practice address

6801 Phoenix Ave Ste 2
Fort Smith, AR 72903-5299

Phone

(479) 384-5378

Fax

(479) 385-5379

NPI assigned

Aug 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ, AR2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Northwest Arkansas Ambulatory Services, LLCGroup PAC ID 3779827993, 50 clinicians

Mercy Clinic Fort Smith CommunitiesGroup PAC ID 3870668510, 361 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Mercy Clinic Fort Smith Communities

  • Multi-Specialty Clinic/Center
  • Fort Smith, AR
  • NPI 1902073620
  Medicare reassignment Care Compare group NPD
• Mercy Northwest Arkansas Ambulatory Services LLC

  • Urgent Care Clinic/Center
  • Springdale, AR
  • NPI 1366922320
  Medicare reassignment Care Compare group
• Arizona Emergency Medicine Specialists PC

  • Emergency Medicine Physician
  • Lake Havasu City, AZ
  • NPI 1134439706
  Medicare reassignment
• Truecare Urgent Care LLC

  • Urgent Care Clinic/Center
  • Lake Havasu City, AZ
  • NPI 1063051936
  Medicare reassignment
• Mercy Clinic Fort Smith Communities

  • Endocrinology, Diabetes & Metabolism Physician
  • Fort Smith, AR
  • NPI 1790258002
  NPD
• Mercy Health Northwest Arkansas Communities

  • Multi-Specialty Clinic/Center
  • Rogers, AR
  • NPI 1265490916
  NPD (past)
• Burt Faibisoff, MD, PLLC

  • Plastic Surgery Physician
  • Lake Havasu City, AZ
  • NPI 1336396761
  NPD (past)

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1780691816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 775641",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606775641",
            "telephone_number": "314-364-4200",
            "fax_number": "314-364-6321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 PHOENIX AVE STE 2",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035299",
            "telephone_number": "479-384-5378",
            "fax_number": "479-385-5379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLERIN",
        "first_name": "MICHELLE",
        "middle_name": "R",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-02",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-575",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ID",
            "license": "PA-575",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807321700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pediatric Partners PA
• Pediatric Therapy Connections LLC
• Abby Elizabeth Pekarek
• Liliana Isabel Pelayo
• Deanna R Pelland, RN
• Charles Pennington, LMSW
• Crystal Rose Pennington, M.D.
• Marilyn C Pennington, LCSW
• Wade Pennington, PT, DPT
• William Gregory Penny, M.D.

• Physician Assistant in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; 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.