Individual provider Active NPI

Dijana Stjepanovic, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1861894164
Registry record updated Mar 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601007118 Issued in MI
Practice address
145 Michigan St NE Ste 3100
Grand Rapids, MI 49503-2563
Phone
(616) 954-9800
Fax
(616) 954-2116
NPI assigned
Sep 18, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2020

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 5601007118 MI Primary

Addresses

Primary practice location

145 Michigan St NE Ste 3100
Grand Rapids, MI 49503-2563

Mailing address

5800 Foremost Dr SE Ste 300
Grand Rapids, MI 49546-7062
Phone (616) 954-9800

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
I20141016000941 MI Practitioner - Physician Assistant 9032330063 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

12460 Riley St
Holland, MI 49424-8217
Phone (616) 399-6500

145 Michigan St NE
Suite 3100
Grand Rapids, MI 49503-2563
Phone (616) 954-9800

6425 S Harvey St
Norton Shores, MI 49444-9739
Phone (231) 737-3469

710 Kenmoor Ave SE
Suite 200
Grand Rapids, MI 49546-2379
Phone (616) 389-1800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5601007118MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Hospitals CurrentSince Mar 15, 2019 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Oct 24, 2016 Accepting new patients
Spectrum Health Hospitals CurrentSince Mar 15, 2019 Accepting new patients
Spectrum Health Primary Care Partners Current Accepting new patients
Trinity Health Grand Haven Hospital CurrentSince Sep 2, 2014 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Oct 24, 2016 Accepting new patients
Emergency Health Partners Muskegon Past Accepting new patients

Locations

1309 Sheldon Rd
Grand Haven, MI 49417
Phone (616) 842-3600

145 Michigan St NE
Ste 3100
Grand Rapids, MI 49503
Phone (616) 954-9800

250 Cherry St SE
Ste 2200
Grand Rapids, MI 49503
Phone (616) 685-5600

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

Organizations & group practices 8

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.

Hospital & facility affiliations 3

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": "1410998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584403200000",
    "number": "1861894164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 FOREMOST DR SE STE 300",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467062",
            "telephone_number": "616-954-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 MICHIGAN ST NE STE 3100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032563",
            "telephone_number": "616-954-9800",
            "fax_number": "616-954-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STJEPANOVIC",
        "first_name": "DIJANA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-18",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.