Kelly Elizabeth Eggiman

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601006558 Issued in MI

Practice address

100 Michigan St NE
Suite A721
Grand Rapids, MI 49503-2560

Phone

(616) 391-3139

Fax

(616) 391-3044

NPI assigned

Dec 3, 2012

Last updated

Dec 3, 2012By the provider in NPPES

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

Other names 1

• Kelly Elizabeth O'Brien Former name

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Vincent Physician Services Hospital and Health Care CenterGroup PAC ID 9638072184, 276 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St Vincent Hospital Hospital, Indianapolis, IN, CCN 150084
• Ascension St Vincent Kokomo Hospital, Kokomo, IN, CCN 150010
• Henry County Memorial Hospital Hospital, New Castle, IN, CCN 150030

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St Vincent Physician Services Hospital and Health Care Center

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1669422234

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• St Vincent Physician Services Hospital and Health Care Center

  • Durable Medical Equipment & Medical Supplies
  • Carmel, IN
  • NPI 1366689044
  NPD
• Michigan Medical Patient Care

  • Durable Medical Equipment & Medical Supplies
  • Holland, MI
  • NPI 1871741652
  NPD (past)
• Saint Vincent Physician Services, Inc.

  • Family Medicine Physician
  • Worcester, MA
  • NPI 1013997329

  Physician Assistant

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Henry County Memorial Hospital

  • General Acute Care Hospital
  • New Castle, IN
  • NPI 1356428429
  Care Compare affiliation
• St. Joseph Hospital & Health Center, Inc.

  dba Ascension St. Vincent Kokomo

  • General Acute Care Hospital
  • Kokomo, IN
  • NPI 1780625442
  Care Compare affiliation
• St. Vincent Hospital & Health Care Center, Inc.

  dba Ascension St. Vincent Hospital

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1306898960
  Care Compare affiliation
• St. Vincent Hospital & Health Care Center, Inc.

  dba Ascension St. Vincent - Avon

  • General Acute Care Hospital
  • Avon, IN
  • NPI 1851833230
  Care Compare affiliation

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

{
    "created_epoch": "1354492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354492800000",
    "number": "1811232879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "SUITE A721",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-391-3139",
            "fax_number": "616-391-3044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGGIMAN",
        "first_name": "KELLY",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-03",
        "last_updated": "2012-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "O'BRIEN",
            "middle_name": "ELIZABETH",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michael Angelo Egan I, LMSW
• Dorace A Egeland, LMSW
• Eric J Egeler, M.D.
• Aaron T Eggebeen, MD
• Pamela Kay Eggers, RPH
• Ashley Eggleston
• Brady Eggleston
• Elizabeth Ames Eggleston, MS, RD
• Robert Lewis Eggleston III, MA, LLPC
• Rosanne Scigliano Eggleston, DDS

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2012; 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.