SUSANNE PETTIGREW PA-C
NPI 1780686550
Physician Assistant - Medical in Grand Rapids, MI

Q: What is Susanne Pettigrew's NPI number?

The NPI number for Susanne Pettigrew is 1780686550. It was assigned to this individual provider in the NPPES registry on August 11, 2005.

Q: What is Susanne Pettigrew's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: Is Susanne Pettigrew enrolled in Medicare?

No. Susanne Pettigrew has opted out of Medicare through October 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Susanne Pettigrew was last updated on March 30, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since August 11, 2005Opted out of Medicare · through Oct 1, 2027

145 MICHIGAN ST NE STE 4400, GRAND RAPIDS, MI 49503(616) 486-6333 Get Directions Write a Review

NPPES record last updated: March 30, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Susanne Pettigrew Pa-c NPPES

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

SUSANNE PETTIGREW PA-C (NPI 1780686550) is an individual medical provider in Grand Rapids, Michigan, licensed in Michigan (5601001592) and active in the NPI registry since August 2005. She has opted out of Medicare through October 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1780686550

Entity TypeIndividualFemale

Primary Taxonomy363AM0700X

Provider Legal NameSUSANNE PETTIGREWCredential: PA-C

Location Address145 MICHIGAN ST NE STE 4400Grand Rapids, MI 49503-2564

Mailing Address985 Gezon Pkwy SwWyoming, MI 49509-9563 · (616) 252-4655 · Fax (616) 252-0103

Phone(616) 486-6333

Sole ProprietorNo

Enumeration DateAugust 11, 2005

Last NPPES UpdateMarch 30, 2020

NPPES CertifiedMarch 30, 2020

✔ NPI 1780686550 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in MI · 5601001592

145 MICHIGAN ST NE STE 4400, Grand Rapids, MI 49503

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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

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Opted out of Medicare

Susanne Pettigrew Pa-c has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 1, 2025 through October 1, 2027.

Opt-Out Effective DateOctober 1, 2025

Opt-Out In Effect ThroughOctober 1, 2027Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

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Other Providers at the Same Location NPPES 11

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

DR. JAYNE ELIZABETH PAULSON M.D.

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