Kaitlin Elizabeth Henley, PA-C
Individual provider Active NPI Physician Assistant · Wayland, MI
NPI 1851031975 · NPPES record last updated Aug 6, 2024
Key facts
- NPI
- 1851031975
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601012261 (MI)
- Practice address
- 12851 W M 179 Hwy
Wayland, MI 49348-9318 - Phone
- (877) 377-7322
- NPI assigned
- Mar 29, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pennock Hospital
Practice addresses (Care Compare)
12851 W M 179 Hwy
Wayland, MI 49348-9318
Phone (877) 377-7322
Hospital & facility affiliations
- Corewell Health Pennock Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240506004079 | MI | Practitioner - Physician Assistant | 6507246501 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601012261 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pennock Hospital | Current |
Accepting new patients | |
| Pennock Hospital | Current |
Accepting new patients |
Locations
100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242
1005 W Green St
Ste 300
Hastings, MI 49058
Phone (269) 948-8411
12851 W M 179 Hwy
Wayland, MI 49348
Phone (877) 377-7322
Interoperability endpoints
- kmcdonald282625@epic00.corewelldirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601012261 | MI | Yes |
Addresses
Primary practice location
12851 W M 179 Hwy
Wayland, MI 49348-9318
Mailing address
100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560
Other names
- Kaitlin McDonald
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kmcdonald282625@epic00.corewelldirect.org | ||
| FHIR URL | https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/ |
Other providers in Wayland, MI
- Lawrence S Hawkins
- Amelia Carol Hayes
- Erin Hazel
- Kirstin Gail Heft
- Shelley Heijerman
- Carrie Hine
- Keith Michael Hintz
- Alexander Thomas Hoelzel
- Ronald Angelo House II
- Samuel Huizenga
All providers in Wayland, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.