Chantelle Tanya Koch, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601008328 Issued in MI

Practice address

145 Michigan St NE Ste 5500
Grand Rapids, MI 49503-2565

Phone

(616) 267-8540

NPI assigned

Sep 5, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Spectrum Health Primary Care PartnersGroup PAC ID 4587568647, 2,283 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
• Corewell Health Zeeland Hospital Hospital, Zeeland, MI, CCN 230003
• Munson Medical Center Hospital, Traverse City, MI, CCN 230097
• Spectrum Health United Hospital Hospital, Greenville, MI, CCN 230035
• Corewell Health Reed City Hospital Hospital, Reed City, MI, CCN 231323

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ckoch264768@epic00.corewelldirect.org

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.

• Spectrum Health Primary Care Partners

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1235188673
  Medicare reassignment Care Compare group NPD
• Comprehensive Hospital Care P C

  • Internal Medicine Physician
  • Taylor, MI
  • NPI 1891926408
  Medicare reassignment
• Future Comprehensive Care, P.C.

  • Internal Medicine Physician
  • Redford, MI
  • NPI 1174185557
  Medicare reassignment
• Spectrum Health Primary Care Partners

  • Radiology Clinic/Center
  • Grand Rapids, MI
  • NPI 1528374683
  NPD
• Spectrum Health Primary Care Partners

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1689499667
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Munson Medical Center

  • General Acute Care Hospital
  • Traverse City, MI
  • NPI 1952307852
  Care Compare affiliation
• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Reed City Hospital Corporation

  • Critical Access Hospital
  • Reed City, MI
  • NPI 1437259843
  Care Compare affiliation
• Spectrum Health Hospitals

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation
• Spectrum Health United

  • General Acute Care Hospital
  • Greenville, MI
  • NPI 1457304495
  Care Compare affiliation
• Zeeland Community Hospital

  • General Acute Care Hospital
  • Zeeland, MI
  • NPI 1275536344
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1891213336",
    "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": "145 MICHIGAN ST NE STE 5500",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032565",
            "telephone_number": "616-267-8540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOCH",
        "first_name": "CHANTELLE",
        "middle_name": "TANYA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-05",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ckoch264768@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "145 Michigan St NE Ste 5500",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032565",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "145 Michigan St NE Ste 5500",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christopher Kobet, MD
• Kobie Dental PLLC
• Ola Kobierzycki, DDS
• Ryann Koblinski, NP
• Lindsay Kobus, CRNA
• Connie Rosella Koch, AA, CBIS
• Margaret Anne Koch
• Patrick H Koch, CBIS
• Morgan Ashley Kochajda-Watkins, NP
• Lakshmi Kocharla, MD

• Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.