Active NPI
Mary Grace Anne Bauer, PA-C
- Physician Assistant
- Saint Clair Shores, MI
National Provider Identifier
1831688308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601008646
- Practice address
- 25311 Little Mack Ave Ste B
Saint Clair Shores, MI 48081-3301 - Phone
- (586) 498-2400
- NPI assigned
- May 9, 2018
- Last updated
- May 9, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601008646 | MI | Primary |
Addresses
Primary practice location
25311 Little Mack Ave Ste B
Saint Clair Shores, MI 48081-3301
Mailing address
25311 Little Mack Ave Ste B
Saint Clair Shores, MI 48081-3301
Phone (586) 498-2400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601008646 | MI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525824000000",
"number": "1831688308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25311 LITTLE MACK AVE STE B",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480813301",
"telephone_number": "586-498-2400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25311 LITTLE MACK AVE STE B",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480813301",
"telephone_number": "586-498-2400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUER",
"first_name": "MARY GRACE",
"middle_name": "ANNE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-09",
"last_updated": "2018-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601008646",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Clair Shores, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.