NPIMap

Individual provider Active NPI

Michelle Rose Godfrey, PA-C

  • Physician Assistant
  • Canadian Lakes, MI
National Provider Identifier
1881620359
Registry record updated Mar 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004492 Issued in MI
Practice address
8354 100TH Ave Ste 1
Canadian Lakes, MI 49346-8345
Phone
(231) 972-6000
Fax
(231) 972-6003
NPI assigned
Jun 24, 2006
Last updated
Mar 4, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2021

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 5601004492 MI Primary

Addresses

Primary practice location

8354 100TH Ave Ste 1
Canadian Lakes, MI 49346-8345

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560
Phone (616) 486-6790

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mgodfrey52856@epic00.shdirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061012000258 MI Practitioner - Physician Assistant 0143226209 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mecosta County Medical CenterGroup PAC ID 1951215540, 53 clinicians

Practice addresses (Care Compare)

605 Oak St
Big Rapids, MI 49307-2048

8354 100TH Ave
Suite 1
Canadian Lakes, MI 49346-8345
Phone (231) 972-6000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mecosta County Medical Center CurrentSince Jun 5, 2017 Accepting new patients
Mecosta County Medical Center CurrentSince Jun 5, 2017 Accepting new patients
Mecosta County Medical Center Physician Assistant Past Accepting new patients
Mecosta County Medical Center PastSince Mar 7, 2021 Accepting new patients

Locations

14755 215th Ave
Big Rapids, MI 49307
Phone (231) 796-3200

605 Oak St
Big Rapids, MI 49307
Phone (231) 592-1079

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

8354 100th Ave
Stanwood, MI 49346
Phone (231) 972-6000

8354 100th Ave
Ste 1
Stanwood, MI 49346
Phone (231) 972-6000

Interoperability endpoints

  • Direct secure messaging: mgodfrey52856@epic00.corewelldirect.org
  • Direct secure messaging: mgodfrey52856@epic00.shdirect.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1881620359",
    "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",
            "telephone_number": "616-486-6790",
            "fax_number": "616-486-6702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8354 100TH AVE STE 1",
            "city": "CANADIAN LAKES",
            "state": "MI",
            "postal_code": "493468345",
            "telephone_number": "231-972-6000",
            "fax_number": "231-972-6003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODFREY",
        "first_name": "MICHELLE",
        "middle_name": "ROSE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-24",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgodfrey52856@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "8354 100th Ave Ste 1",
            "city": "Canadian Lakes",
            "state": "MI",
            "country_code": "US",
            "postal_code": "493468345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Canadian Lakes, MI

Sources for this page

Verify at the official NPI Registry.