Individual provider Active NPI

Gina Braak, PA-C

  • Physician Assistant
  • Muskegon, MI
National Provider Identifier
1881470474
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601012002 Issued in MI
Practice address
1500 E Sherman Blvd
Muskegon, MI 49444-1849
Phone
(231) 672-3916
NPI assigned
Sep 7, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 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 5601012002 MI Primary

Addresses

Primary practice location

1500 E Sherman Blvd
Muskegon, MI 49444-1849

Mailing address

17097 Roosevelt Rd
Spring Lake, MI 49456-1248

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
I20231221000863 MI Practitioner - Physician Assistant 2365892080 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Synanon IncGroup PAC ID 6204899172, 7 clinicians
Lake Michigan Observation Services PLLCGroup PAC ID 3375938889, 30 clinicians

Practice addresses (Care Compare)

1091 S Beacon Blvd
Grand Haven, MI 49417-2607
Phone (616) 842-3600

1500 E Sherman Blvd
Mercy Health
Muskegon, MI 49444-1849
Phone (231) 728-4601

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601012002MIMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: gglynn148776@direct.trinity-health.org
  • Direct secure messaging: gina.braak.1@22386.direct.athenahealth.com

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": "1694044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1881470474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17097 ROOSEVELT RD",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494561248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E SHERMAN BLVD",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441849",
            "telephone_number": "231-672-3916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAAK",
        "first_name": "GINA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-07",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

Verify at the official NPI Registry.