Individual provider Active NPI

Lauren Renee Donnellon, PA-C

  • Physician Assistant
  • Kalamazoo, MI
National Provider Identifier
1881400984
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601012789 Issued in MI
Practice address
1535 Gull Rd Ste 205
Kalamazoo, MI 49048-1638
Phone
(269) 343-7296
Fax
(269) 343-9849
NPI assigned
Dec 4, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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 5601012789 MI Primary

Addresses

Primary practice location

1535 Gull Rd Ste 205
Kalamazoo, MI 49048-1638

Mailing address

1535 Gull Rd Ste 205
Kalamazoo, MI 49048-1638
Phone (269) 343-7296

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
I20250128001960 MI Practitioner - Physician Assistant 5698204204 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Western Michigan Un Homer Stryker School of Med, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ascension Medical Group PromedGroup PAC ID 7315856077, 255 clinicians

Practice addresses (Care Compare)

1521 Gull Rd
Kalamazoo, MI 49048-1640
Phone (269) 226-5165

1535 Gull Rd
Kalamazoo, MI 49048-1650
Phone (269) 276-0800

7901 Angling Rd
Portage, MI 49024-0714

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Promed Healthcare CurrentSince Jan 23, 2025 Accepting new patients
Ascension Medical Group Promed CurrentSince Jan 23, 2025 Accepting new patients
Ascension Medical Group Promed Past Accepting new patients

Locations

1535 Gull Rd
Ste 205
Kalamazoo, MI 49048
Phone (269) 381-3521

1717 Shaffer St
Ste 2
Kalamazoo, MI 49048

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

Organizations & group practices 3

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 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": "1733270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1881400984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 GULL RD STE 205",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481638",
            "telephone_number": "269-343-7296",
            "fax_number": "269-343-9849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1535 GULL RD STE 205",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481638",
            "telephone_number": "269-343-7296",
            "fax_number": "269-343-9849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLON",
        "first_name": "LAUREN",
        "middle_name": "RENEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-04",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.