Individual provider Active NPI

Lara Katherine Shwayhat, PA-C

  • Physician Assistant
  • Pontiac, MI
National Provider Identifier
1972803930
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005855 Issued in MI
Practice address
44555 Woodward Ave
Suite 104
Pontiac, MI 48341
Phone
(586) 216-3407
NPI assigned
Oct 25, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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 5601005855 MI Primary

Addresses

Primary practice location

44555 Woodward Ave
Suite 104
Pontiac, MI 48341

Mailing address

24 Frank Lloyd Wright Drive
Suite J2000
Ann Arbor, MI 48105
Phone (734) 747-6766

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
I20110103001058 MI Practitioner - Physician Assistant 9436347606 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

44428 Woodward Ave
Suite 102
Pontiac, MI 48341-5009
Phone (734) 712-8700

51341 W Huron River Dr
Trinity Health Iha Medical Group Primary Ca
Van Buren Township, MI 48111-2571
Phone (734) 997-0304

Hospital & facility affiliations

  • Trinity Health Oakland Hospital Hospital, Pontiac, MI, CCN 230029

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601005855MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Service Corporation CurrentSince Feb 1, 2025 Accepting new patients
Iha Health Services Corporation CurrentSince Feb 1, 2025 Accepting new patients
Henry Ford Health System Physician Assistant CurrentSince Aug 1, 2019 Accepting new patients
Henry Ford Health System CurrentSince Aug 1, 2019 Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

28050 Grand River Ave
Farmington Hills, MI 48336
Phone (248) 471-8000

44555 Woodward Ave
Ste 104
Pontiac, MI 48341
Phone (248) 334-5400

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

44201 Dequindre Rd
Troy, MI 48085
Phone (248) 471-8255

Organizations & group practices 5

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 1

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": "1287964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1972803930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DRIVE",
            "address_2": "SUITE J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48105",
            "telephone_number": "734-747-6766",
            "fax_number": "734-222-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44555 WOODWARD AVE",
            "address_2": "SUITE 104",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "48341",
            "telephone_number": "586-216-3407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHWAYHAT",
        "first_name": "LARA",
        "middle_name": "KATHERINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-25",
        "last_updated": "2025-03-12",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontiac, MI

Sources for this page

Verify at the official NPI Registry.