NPIMap

Individual provider Active NPI

Devon E Fenner, PA-C

  • Physician Assistant
  • Port Huron, MI
National Provider Identifier
1972160505
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
750 Lakeview Ave
Port Huron, MI 48060-2104
Phone
(810) 488-5795
NPI assigned
May 20, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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 MI Primary

Addresses

Primary practice location

750 Lakeview Ave
Port Huron, MI 48060-2104

Mailing address

4100 Campus Ridge Dr
Midland, MI 48640-6139
Phone (810) 488-5795

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
I20191021001026 MI Practitioner - Physician Assistant 4789915976 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mymichigan Medical Center MidlandGroup PAC ID 2264323633, 507 clinicians

Practice addresses (Care Compare)

4000 Wellness Dr
Midland, MI 48670-2000
Phone (989) 633-8018

4100 Campus Ridge Dr
Midland, MI 48640-6139
Phone (989) 839-3060

4500 Campus Ridge Dr
Midland, MI 48640-6123
Phone (989) 837-9250

Hospital & facility affiliations

  • Mymichigan Medical Center Midland Hospital, Midland, MI, CCN 230222
  • Mymichigan Medical Center Saginaw Hospital, Saginaw, MI, CCN 230077
  • Mymichigan Medical Center Clare Hospital, Clare, MI, CCN 230180
  • Mymichigan Medical Center Gladwin Hospital, Gladwin, MI, CCN 231325

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Gladwin CurrentSince Nov 18, 2019 Accepting new patients
Mymichigan Medical Center Clare Physician Assistant CurrentSince Nov 18, 2019 Accepting new patients
Mymichigan Medical Center Clare CurrentSince Nov 18, 2019 Accepting new patients
Mymichigan Medical Center Midland CurrentSince Oct 9, 2019 Accepting new patients
Mymichigan Medical Center Alma CurrentSince Mar 23, 2021 Accepting new patients
Mymichigan Medical Center Gladwin CurrentSince Nov 18, 2019 Accepting new patients
Mymichigan Medical Center Alma CurrentSince Mar 23, 2021 Accepting new patients
Mymichigan Medical Center Midland CurrentSince Oct 9, 2019 Accepting new patients

Locations

315 E Warwick Dr
Ste C
Alma, MI 48801
Phone (989) 463-9300

700 W 5th St
Clare, MI 48617
Phone (989) 386-9911

515 Quarter St
Gladwin, MI 48624
Phone (989) 246-6201

4100 Campus Ridge Dr
Midland, MI 48640
Phone (989) 488-5450

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

4500 N Campus Ridge Dr
Midland, MI 48640
Phone (989) 837-9250

Interoperability endpoints

  • Direct secure messaging: dfenner90368@mymichiganhealth.midirect.net

Organizations & group practices 10

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 6

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": "1558310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1972160505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 CAMPUS RIDGE DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486406139",
            "telephone_number": "810-488-5795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 LAKEVIEW AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480602104",
            "telephone_number": "810-488-5795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENNER",
        "first_name": "DEVON",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-20",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

Verify at the official NPI Registry.