Individual provider Active NPI

Brent James Solberg, PA-C

  • Physician Assistant
  • Muskegon, MI
National Provider Identifier
1922433507
Registry record updated Dec 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601006749 Issued in MI
Practice address
1400 Mercy Dr
Suite 100
Muskegon, MI 49444-1836
Phone
(231) 733-1326
NPI assigned
Sep 13, 2013
Last updated
Dec 7, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 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 5601006749 MI Primary

Addresses

Primary practice location

1400 Mercy Dr
Suite 100
Muskegon, MI 49444-1836

Mailing address

1400 Mercy Dr
Suite 100
Muskegon, MI 49444-1836
Phone (231) 733-1326

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bsolberg36644@direct.trinity-health.org Direct

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
I20131205000776 MI Practitioner - Physician Assistant 2769619378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10047 Crossroad CT SE
Caledonia, MI 49316-7316
Phone (616) 685-8850

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone (616) 685-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601006749MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group Physician Assistant CurrentSince Aug 16, 2021 Accepting new patients
Advantage Health/Saint Mary's Medical Group CurrentSince Aug 16, 2021 Accepting new patients
Advantage Health Saint Mary's Medical Group Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

Organizations & group practices 4

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 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": "1379030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638835200000",
    "number": "1922433507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 MERCY DR",
            "address_2": "SUITE 100",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441836",
            "telephone_number": "231-733-1326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MERCY DR",
            "address_2": "SUITE 100",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441836",
            "telephone_number": "231-733-1326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLBERG",
        "first_name": "BRENT",
        "middle_name": "JAMES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-13",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bsolberg36644@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "Trinity Health Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1400 Mercy Dr",
            "address_2": "Suite 100",
            "city": "Muskegon",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494441836",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

Verify at the official NPI Registry.