Individual provider Active NPI

Kelley Eileen Giovannini, PA-C

  • Physician Assistant
  • Chelsea, MI
National Provider Identifier
1861861874
Registry record updated Dec 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601007528 Issued in MI
Practice address
14650 East Old US Highway 12
Suite 306
Chelsea, MI 48118-1804
Phone
(734) 475-4003
NPI assigned
Sep 20, 2015
Last updated
Dec 12, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1140 NH
Physician Assistant 363A00000X 5601007528 MI Primary

Addresses

Primary practice location

14650 East Old US Highway 12
Suite 306
Chelsea, MI 48118-1804

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

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
I20180508000026 MI Practitioner - Physician Assistant 2163728023 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1801 Briarwood Cir
Ann Arbor, MI 48108-3347
Phone (734) 539-5000

4250 Plymouth Rd
Ann Arbor, MI 48109-2700
Phone (734) 764-0231

4260 Plymouth Rd
Ann Arbor, MI 48109-2700
Phone (734) 936-4000

4270 Plymouth Rd
Ann Arbor, MI 48109-2700
Phone (734) 936-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1140NHMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan Physician Assistant CurrentSince Apr 24, 2018 Accepting new patients
Regents of the University of Michigan CurrentSince Apr 24, 2018 Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

1500 E Medical Center Dr
Fl 2
Ann Arbor, MI 48109
Phone (734) 936-5738

1801 Briarwood Cir
Ann Arbor, MI 48108
Phone (734) 539-5000

3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229

4260 Plymouth Rd
Ann Arbor, MI 48109
Phone (734) 647-5715

14650 E Old US Highway 12
Ste 201
Chelsea, MI 48118
Phone (734) 433-4504

14650 E Old US Highway 12
Ste 306
Chelsea, MI 48118
Phone (734) 475-4003

14700 E Old US Highway 12
Chelsea, MI 48118
Phone (734) 475-1321

775 S Main St
Chelsea, MI 48118
Phone (313) 995-3764

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1442707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544572800000",
    "number": "1861861874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14650 EAST OLD US HIGHWAY 12",
            "address_2": "SUITE 306",
            "city": "CHELSEA",
            "state": "MI",
            "postal_code": "481181804",
            "telephone_number": "734-475-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIOVANNINI",
        "first_name": "KELLEY",
        "middle_name": "EILEEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-20",
        "last_updated": "2018-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "1140",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chelsea, MI

Sources for this page

Verify at the official NPI Registry.