Individual provider Active NPI

Timothy John Carpenter, P.A.-C

  • Medical Physician Assistant
  • Hastings, MI
National Provider Identifier
1801566401
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
1009 W Green St
Hastings, MI 49058-1790
Phone
(219) 738-5510
NPI assigned
Sep 15, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

1009 W Green St
Hastings, MI 49058-1790

Mailing address

4100 Embassy Dr SE
Grand Rapids, MI 49546-2416
Phone (616) 975-1845

Other practice location 1

8333 Felch St
Zeeland, MI 49464-1600
Phone (866) 703-2452

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, MI2 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

Enrollment IDStateProvider typePAC IDDetails
I20220126001422 IN Practitioner - Physician Assistant 9830581776 Reassigns benefits to 1 organization
I20240112002396 MI Practitioner - Physician Assistant 9830581776 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ecs Western Michigan PCGroup PAC ID 8628327384, 202 clinicians

Practice addresses (Care Compare)

1108 W State St
Hastings, MI 49058-9711
Phone (269) 948-3360

615 S Bower St
Greenville, MI 48838-2614
Phone (866) 542-7910

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
70.94
Improvement activities
40
Cost
92.94

Merit-based Incentive Payment System (MIPS)

Final score
97.48 of 100Reported as group
Quality
89.26
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America LLC CurrentSince Jan 25, 2022 Accepting new patients
Cep America LLC CurrentSince Jan 25, 2022 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

8701 Broadway
Merrillville, IN 46410
Phone (219) 738-4926

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1631664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1801566401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 EMBASSY DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462416",
            "telephone_number": "616-975-1845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 W GREEN ST",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490581790",
            "telephone_number": "219-738-5510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8333 Felch St",
            "address_purpose": "LOCATION",
            "city": "Zeeland",
            "state": "MI",
            "postal_code": "494641600",
            "country_code": "US",
            "telephone_number": "866-703-2452",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARPENTER",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-15",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hastings, MI

Sources for this page

Verify at the official NPI Registry.