Cassidy Jae Hanson, PA-C
Individual provider Active NPI Physician Assistant · Rock, MI
NPI 1972339166 · NPPES record last updated Sep 26, 2024
Key facts
- NPI
- 1972339166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601012721 (MI)
- Practice address
- 4289 E Maple Ridge 37TH Rd
Rock, MI 49880-9582 - Phone
- (906) 420-4759
- NPI assigned
- Sep 12, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Francis Hospital
Practice addresses (Care Compare)
3409 Ludington St
Escanaba, MI 49829-4213
Hospital & facility affiliations
- Osf St Francis Hospital and Medical Group
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240924004431 | MI | Practitioner - Physician Assistant | 1355882853 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601012721 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Francis Hospital | Physician Assistant | Current |
Accepting new patients |
| St Francis Hospital | Current |
Accepting new patients |
Locations
3409 Ludington St
Ste 104
Escanaba, MI 49829
Phone (906) 786-8343
3409 Ludington St
Ste 100
Escanaba, MI 49829
Phone (906) 789-4414
Interoperability endpoints
- cassidy.hanson@507768006705156.direct.elationemr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601012721 | MI | Yes |
Addresses
Primary practice location
4289 E Maple Ridge 37TH Rd
Rock, MI 49880-9582
Mailing address
545 County Road HQ
Marquette, MI 49855-8855
Phone (906) 273-0072
Other practice location 1
545 County Road Hq
Marquette, MI 49855-8855
Phone (906) 273-0072
Other providers in Rock, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.