Individual provider Active NPI

Jennifer Squires, P.A.

  • Physician Assistant
  • Kalamazoo, MI
National Provider Identifier
1972051712
Registry record updated Sep 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601007887 Issued in MI
Practice address
1701 Gull Rd
Kalamazoo, MI 49048-1609
Phone
(269) 226-7000
NPI assigned
Sep 21, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2016

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 5601007887 MI Primary

Addresses

Primary practice location

1701 Gull Rd
Kalamazoo, MI 49048-1609

Mailing address

1701 Gull Rd
Kalamazoo, MI 49048-1609

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
I20161205001440 MI Practitioner - Physician Assistant 6204116486 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ascension Medical Group PromedGroup PAC ID 7315856077, 255 clinicians

Practice addresses (Care Compare)

1521 Gull Rd
Kalamazoo, MI 49048-1640
Phone (269) 226-5165

7901 Angling Rd
Portage, MI 49024-0714

8450 N 32ND St
Richland, MI 49083-9418
Phone (616) 226-2500

Hospital & facility affiliations

  • Borgess Medical Center Hospital, Kalamazoo, MI, CCN 230117
  • Beacon Plainwell Long-term care hospital, Plainwell, MI, CCN 232034

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601007887MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Promed Healthcare CurrentSince Nov 21, 2016 Accepting new patients
Ascension Medical Group Promed CurrentSince Nov 21, 2016 Accepting new patients
Ascension Medical Group Promed Past Accepting new patients

Locations

1701 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-2550

2490 S 11th St
Ste 201
Kalamazoo, MI 49009
Phone (269) 343-1535

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

8450 N 32nd St
Richland, MI 49083
Phone (269) 226-2500

1241 W Broadway St
Three Rivers, MI 49093
Phone (269) 273-9539

Organizations & group practices 3

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 2

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": "1474416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474416000000",
    "number": "1972051712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 GULL RD",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 GULL RD",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481609",
            "telephone_number": "269-226-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SQUIRES",
        "first_name": "JENNIFER",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-21",
        "last_updated": "2016-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.