Active NPI
Paulette Bagnall, PA-C
- Physician Assistant
- Mount Clemens, MI
National Provider Identifier
1972928646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601001994
- Practice address
- 43525 Elizabeth St
Mount Clemens, MI 48043-1034 - Phone
- (586) 469-5491
- NPI assigned
- Mar 4, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601001994 | MI | Primary |
Addresses
Primary practice location
43525 Elizabeth St
Mount Clemens, MI 48043-1034
Mailing address
43525 Elizabeth St
Mount Clemens, MI 48043-1034
Phone (586) 469-5491
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601001994 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Macomb | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Public Health or Welfare Agency
- Mount Clemens, MI
- NPI 1760462253
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393891200000",
"number": "1972928646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43525 ELIZABETH ST",
"city": "MOUNT CLEMENS",
"state": "MI",
"postal_code": "480431034",
"telephone_number": "586-469-5491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43525 ELIZABETH ST",
"city": "MOUNT CLEMENS",
"state": "MI",
"postal_code": "480431034",
"telephone_number": "586-469-5491"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAGNALL",
"first_name": "PAULETTE",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-03-04",
"last_updated": "2014-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601001994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Clemens, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.