Individual provider Active NPI

Elizabeth Way, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1932155215
Registry record updated Jun 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004315 Issued in MI
Practice address
300 Lafayette Ave SE
Grand Rapids, MI 49503-4650
Phone
(616) 616-6855
Fax
(616) 685-8910
NPI assigned
May 26, 2006
Last updated
Jun 30, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2009

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 5601004315 MI Primary

Addresses

Primary practice location

300 Lafayette Ave SE
Grand Rapids, MI 49503-4650

Mailing address

245 State St SE
Grand Rapids, MI 49503-4328
Phone (616) 685-1808

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
I20041028000816 MI Practitioner - Physician Assistant 4082676424 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601004315MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group Physician Assistant CurrentSince Jan 15, 2013 Accepting new patients
Advantage Health/Saint Mary's Medical Group CurrentSince Jan 15, 2013 Accepting new patients
Pine Rest Christian Mental Health Services Physician Assistant Past Accepting new patients
Pine Rest Christian Mental Health Services Past Accepting new patients
Saint Mary's Health Services Past Accepting new patients
Trinity Health - Michigan Past Accepting new patients

Locations

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

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

245 State St SE
Ste 1A
Grand Rapids, MI 49503

1900 44th St SE
Kentwood, MI 49508
Phone (616) 685-8500

475 S State St
Sparta, MI 49345
Phone (616) 685-1300

Interoperability endpoints

  • Direct secure messaging: eway36809@direct.trinity-health.org

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246320000000",
    "number": "1932155215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 STATE ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034328",
            "telephone_number": "616-685-1808",
            "fax_number": "616-685-1850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LAFAYETTE AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034650",
            "telephone_number": "616-616-6855",
            "fax_number": "616-685-8910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAY",
        "first_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-26",
        "last_updated": "2009-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.