Kelly J Gingras, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601005311 Issued in MI

Practice address

18101 Oakwood Blvd
Dearborn, MI 48124-4089

Phone

(313) 982-5440

NPI assigned

May 4, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Beaumont Medical Group Hospital Based ServicesGroup PAC ID 3072875889, 575 clinicians

Beaumont Medical Group- Specialty ServicesGroup PAC ID 7214299866, 868 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beaumont Hospital - Dearborn Hospital, Dearborn, MI, CCN 230020
• Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kgingras1235155@epic00.shdirect.org

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.

• Beaumont Medical Group- Specialty Services

  • Surgery Physician
  • Royal Oak, MI
  • NPI 1578072906
  Medicare reassignment Care Compare group NPD
• Beaumont Medical Group Hospital -Based Services

  • Hospitalist Physician
  • Royal Oak, MI
  • NPI 1427567858
  Medicare reassignment Care Compare group
• Henry Ford Health System

  • Physician Assistant
  • Detroit, MI
  • NPI 1811073901
  Medicare reassignment NPD
• Henry Ford Health System

  • Community/Retail Pharmacy
  • Plymouth, MI
  • NPI 1942931720
  NPD
• Oakwood Group IX, LLC

  • Internal Medicine Physician
  • Dearborn, MI
  • NPI 1720050917
  NPD (past)
• Oakwood Youth Programs, LLC

  • Physical Medicine & Rehabilitation Physician
  • Dearborn, MI
  • NPI 1790959120
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Oakwood Healthcare Inc

  • Community Health Clinic/Center
  • Dearborn, MI
  • NPI 1790414670

  Hospital

  Care Compare affiliation
• Oakwood Healthcare, Inc.

  • General Acute Care Hospital
  • Dearborn, MI
  • NPI 1740230119
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Royal Oak, MI
  • NPI 1689653305
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  Care Compare affiliation

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1972551935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18101 OAKWOOD BLVD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481244089",
            "telephone_number": "313-982-5440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GINGRAS",
        "first_name": "KELLY",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID #",
            "identifier": "311098079",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO MEDICARE",
            "identifier": "PA25091",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBMITTER NO.",
            "identifier": "353077",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksmith59918@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "18101 Oakwood Blvd",
            "city": "Dearborn",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481244089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vanessa Gibson, MS, LLP
• Gwyneth Gielow
• Victoria R Gilbert
• Monay Gill
• Albino Felix Gimenez, M.D.
• James Robert Giordano, D.D.S.
• Sherry Girard
• Alyssa Kate Girardin, PAC
• Giza & Associates DDS PLLC
• Nadine Gizak

• Physician Assistant in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.