NPIMap

Individual provider Active NPI

Kimberly L Verellen, PA-C

  • Physician Assistant
  • Brown City, MI
National Provider Identifier
1891755104
Registry record updated Nov 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601003348 Issued in MI
Practice address
4472 Main St
Brown City, MI 48416-7908
Phone
(810) 346-2751
Fax
(810) 346-3238
NPI assigned
Mar 23, 2006
Last updated
Nov 17, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2011

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 5601003348 MI Primary

Addresses

Primary practice location

4472 Main St
Brown City, MI 48416-7908

Mailing address

228 School House Dr
Imlay City, MI 48444-1242
Phone (810) 724-4021

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
I20100810000051 MI Practitioner - Physician Assistant 0749313930 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marlette Regional HospitalGroup PAC ID 3971408121, 32 clinicians

Practice addresses (Care Compare)

4472 Main St
Brown City, MI 48416-7908
Phone (810) 346-2752

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Deckerville Community Hospital, Inc CurrentSince Jan 1, 2025 Accepting new patients
Deckerville Community Hospital, Inc. CurrentSince Jan 1, 2025 Accepting new patients
Marlette Regional Hospital CurrentSince May 10, 2010 Accepting new patients
Hills & Dales General Hospital, Inc. CurrentSince Jan 1, 2025 Accepting new patients
Marlette Regional Hospital CurrentSince Jan 1, 2025 Accepting new patients
Marlette Regional Hospital CurrentSince May 10, 2010 Accepting new patients
Hills & Dales General Hospital, Inc. CurrentSince Jan 1, 2025 Accepting new patients
Marlette Regional Hospital Past Accepting new patients
Marlette Regional Hospital Past Accepting new patients

Locations

4472 Main St
Brown City, MI 48416
Phone (810) 346-2751

4675 Hill St
Cass City, MI 48726
Phone (989) 872-2121

3559 Pine St
Deckerville, MI 48427
Phone (810) 376-2835

2750 Main St
Ste 5
Marlette, MI 48453
Phone (989) 635-4050

2770 Main St
Marlette, MI 48453
Phone (989) 635-4000

2771 Angle St
Marlette, MI 48453
Phone (989) 712-4214

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/i-zcCbJ35X2O5bJkqEF8dvUIAeQf3o9y/
  • Direct secure messaging: kverellen163897@direct.covenanthealthcare.com

Organizations & group practices 12

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 8

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": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321488000000",
    "number": "1891755104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 SCHOOL HOUSE DR",
            "city": "IMLAY CITY",
            "state": "MI",
            "postal_code": "484441242",
            "telephone_number": "810-724-4021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4472 MAIN ST",
            "city": "BROWN CITY",
            "state": "MI",
            "postal_code": "484167908",
            "telephone_number": "810-346-2751",
            "fax_number": "810-346-3238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERELLEN",
        "first_name": "KIMBERLY",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-23",
        "last_updated": "2011-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brown City, MI

Sources for this page

Verify at the official NPI Registry.