Individual provider Active NPI

Michelle Vicky Wolfsen, PA-C

  • Physician Assistant
  • Grand Haven, MI
National Provider Identifier
1871574046
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004565 Issued in MI
Practice address
15100 Whittaker Way
Grand Haven, MI 49417-8696
Phone
(616) 774-8345
NPI assigned
Nov 7, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 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 5601004565 MI Primary

Addresses

Primary practice location

15100 Whittaker Way
Grand Haven, MI 49417-8696

Mailing address

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

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/

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
I20060201000820 MI Practitioner - Physician Assistant 6709890478 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Specialty ServicesGroup PAC ID 2365439544, 87 clinicians
Spectrum Health Primary Care PartnersGroup PAC ID 4587568647, 2,283 clinicians

Practice addresses (Care Compare)

1500 E Sherman Blvd
Muskegon, MI 49444-1849
Phone (231) 672-3883

15100 Whittaker Way
Grand Haven, MI 49417-8696
Phone (616) 772-4644

4444 Kalamazoo Ave SE
200 Corewell Health Medical Group West
Kentwood, MI 49508-4600
Phone (616) 391-5600

Hospital & facility affiliations

  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
  • Trinity Health Muskegon Hospital Hospital, Muskegon, MI, CCN 230066
  • Corewell Health Zeeland Hospital Hospital, Zeeland, MI, CCN 230003

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601004565MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Primary Care Partners Current Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Apr 17, 2023 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Apr 17, 2023 Accepting new patients
Astoria Medical P C Past Accepting new patients

Locations

15100 Whittaker Way
Grand Haven, MI 49417
Phone (616) 935-6200

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

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

Interoperability endpoints

  • Direct secure messaging: mwolfsen84258@epic00.corewelldirect.org

Organizations & group practices 5

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 4

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": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1871574046",
    "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": "15100 WHITTAKER WAY",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494178696",
            "telephone_number": "616-774-8345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLFSEN",
        "first_name": "MICHELLE",
        "middle_name": "VICKY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-07",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "15100 Whittaker Way",
            "city": "Grand Haven",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494178696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Haven, MI

Sources for this page

Verify at the official NPI Registry.