SHELBY PETERSEN
NPI 1245006709
Physician Assistant in Grand Rapids, MI

Q: What is Shelby Petersen's NPI number?

The NPI number for Shelby Petersen is 1245006709. It was assigned to this individual provider in the NPPES registry on November 27, 2023.

Q: What is Shelby Petersen's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Shelby Petersen was last updated on July 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since November 27, 2023PECOS EnrolledAccepts Medicare Assignment

4100 EMBASSY DR SE STE 400, GRAND RAPIDS, MI 49546(822) 061-6988 Get Directions Write a Review

NPPES record last updated: July 22, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Shelby Petersen NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHELBY PETERSEN (NPI 1245006709) is an individual physician assistant in Grand Rapids, Michigan, licensed in Michigan (5601012426) and active in the NPI registry since November 2023. She is enrolled in Medicare PECOS, is affiliated with Corewell Health Pennock Hospital, and is a graduate of Wayne State University School Of Medicine (2024).

NPPES Registry Identity

NPI1245006709

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameSHELBY PETERSEN

Location Address4100 EMBASSY DR SE STE 400Grand Rapids, MI 49546-2416

Mailing Address4100 Embassy Dr Se Ste 400Grand Rapids, MI 49546-2416

Phone(822) 061-6988

Sole ProprietorNo

Medical School CMSWayne State University School Of MedicineGraduated 2024

Enumeration DateNovember 27, 2023

Last NPPES UpdateJuly 22, 2024

NPPES CertifiedJuly 17, 2024

✔ NPI 1245006709 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in MI · 5601012426

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

4100 EMBASSY DR SE STE 400, Grand Rapids, MI 49546

Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Shelby Petersen is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8729519566

PECOS Enrollment IDI20241003001263

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Corewell Health Pennock Hospital

Critical Access Hospitals · Hastings, MI

4/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number231339

Location1009 W Green StHastings, MI 49058 · Barry County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49546 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.74 typical visit price

range $54.34 – $166.68

Typical copayment $21.18 (range $13.58 – $41.67)

Most-billed visit code 99203

Established Patient

$68.07 typical visit price

range $17.09 – $135.40

Typical copayment $17.01 (range $4.27 – $33.85)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SAMUEL ALEXANDER MERCHUN PA-C

Physician Assistant (Medical)