Theresa Jean Pebbles, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601005030 Issued in MI

Practice address

1445 Sheldon Rd
Ste 300
Grand Haven, MI 49417-2479

Phone

(616) 296-1500

Fax

(616) 296-1502

NPI assigned

Jun 8, 2007

Last updated

Nov 15, 2024By 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

• Theresa Jean Conway Former name

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

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Noch Physician Billing Company LLCGroup PAC ID 8527078583, 7 clinicians

Mercy Physician NetworkGroup PAC ID 8921996307, 109 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trinity Health Muskegon Hospital Hospital, Muskegon, MI, CCN 230066
• Trinity Health Grand Haven Hospital Hospital, Grand Haven, MI, CCN 230174

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: theresa.pebbles.2@22386.direct.athenahealth.com
• Direct secure messaging: tpebbles44484@direct.trinity-health.org

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.

• Mercy Physician Network

  • Family Medicine Physician
  • Muskegon, MI
  • NPI 1023056744
  Medicare reassignment Care Compare group
• Noch Physician Billing Company LLC

  • Family Medicine Physician
  • Grand Haven, MI
  • NPI 1972550580
  Medicare reassignment Care Compare group
• Mercy Physician Network

  dba Fruitport Family Medicine

  • Family Medicine Physician
  • Fruitport, MI
  • NPI 1639502701

  Physician Assistant

  NPD

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

• Mercy Health Partners

  dba Mercy Health Muskegon

  • General Acute Care Hospital
  • Muskegon, MI
  • NPI 1831132133
  Care Compare affiliation
• Trinity Health Grand Haven Hospital

  • General Acute Care Hospital
  • Grand Haven, MI
  • NPI 1942379284
  Care Compare affiliation

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731628800000",
    "number": "1851594501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776982",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776982",
            "telephone_number": "800-494-5797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 SHELDON RD",
            "address_2": "STE 300",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172479",
            "telephone_number": "616-296-1500",
            "fax_number": "616-296-1502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEBBLES",
        "first_name": "THERESA",
        "middle_name": "JEAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-08",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "CONWAY",
            "middle_name": "JEAN",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Walker M Parmelee, ED.D.
• Mehul B Patel, M.D.
• Paul Creason DDS Family Oral Healthcare
• Heidi Paulsen, RD, ATC
• Christopher Robert Pease, LPC
• Jessica Peerbolte
• Colin William Pellegrom, DDS
• Antoinette Victoria Pelot, PA-C
• Kelly Perez, PAC
• Performance Builders, LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; 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.