Individual provider Active NPI

Priya Rengaraj, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1841782729
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601008636 Issued in MI
Practice address
2750 E Beltline Ave NE FL 3
Grand Rapids, MI 49525-8614
Phone
(616) 447-5820
NPI assigned
Jun 5, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601008636 MI Primary

Addresses

Primary practice location

2750 E Beltline Ave NE FL 3
Grand Rapids, MI 49525-8614

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20230522000529 MI Practitioner - Physician Assistant 2668726878 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5601008636MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Services Corporation CurrentSince Aug 1, 2024 Accepting new patients
Iha Health Service Corporation CurrentSince Aug 1, 2024 Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

Interoperability endpoints

  • Direct secure messaging: prengaraj3536619@direct.trinity-health.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1841782729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 E BELTLINE AVE NE FL 3",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495258614",
            "telephone_number": "616-447-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENGARAJ",
        "first_name": "PRIYA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-05",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.