Individual provider Active NPI

Jeffrey E Hagedorn, PA-C

  • Medical Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1912916743
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5601003331 Issued in MI
Practice address
3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone
(616) 363-7272
Fax
(616) 363-7290
NPI assigned
Aug 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601003331 MI Primary

Addresses

Primary practice location

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746

Mailing address

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone (616) 363-7272

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
I20031105000225 MI Practitioner - Physician Assistant 5395657530 Reassigns benefits to 1 organization

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
Advanced Radiology Services PCGroup PAC ID 4284546516, 252 clinicians

Practice addresses (Care Compare)

100 Michigan Ave NE
Grand Rapids, MI 49503-2560
Phone (616) 363-7272

11751 Hastings Rd
Clarksville, MI 48815-9753
Phone (616) 363-7272

1700 Flowers Crossing Dr NE
Grand Rapids, MI 49525-9523
Phone (616) 363-7272

1840 Wealthy St SE
Grand Rapids, MI 49506-2921
Phone (616) 363-7272

2087 Cascade Farms Dr SE
Grand Rapids, MI 49546-6618
Phone (616) 363-7272

212 S Sullivan Ave
Fremont, MI 49412-1548
Phone (616) 363-7272

3151 Anisko Dr
Grand Rapids, MI 49525-9373
Phone (616) 363-7272

3153 Anisko Dr
Grand Rapids, MI 49525-9373
Phone (616) 363-7272

605 Oak St
Big Rapids, MI 49307-2048
Phone (616) 363-7272

615 S Bower St
Greenville, MI 48838-2614
Phone (616) 363-7272

6460 S Bluebird Ave E
Fremont, MI 49412-7660
Phone (616) 363-7272

6680 Farms End Dr SE
Grand Rapids, MI 49546-6620
Phone (616) 363-7272

8333 Felch St
Zeeland, MI 49464-2608
Phone (616) 363-7272

947 San Jose Dr SE
East Grand Rapids, MI 49506-3421
Phone (616) 363-7272

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.33 of 100Reported as group
Quality
91.31
Improvement activities
40
Cost
79.05

National Provider Directory

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

Organizations & group practices 1

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 4

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": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912916743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7272",
            "fax_number": "616-363-7290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7272",
            "fax_number": "616-363-7290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEDORN",
        "first_name": "JEFFREY",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601003331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.