Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MADISON RAE TIESENGA PA-C
NPI 1912683541
Physician Assistant in Grand Rapids, MI

Q: What is Madison Tiesenga's NPI number?

The NPI number for Madison Tiesenga is 1912683541. It was assigned to this individual provider in the NPPES registry on June 27, 2023. The provider is also known as Madison Rae Brink Pa-C.

Q: What is Madison Tiesenga'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 Madison Tiesenga was last updated on September 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 days 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 June 27, 2023PECOS EnrolledAccepts Medicare Assignment

4069 LAKE DR SE STE 315, GRAND RAPIDS, MI 49546(616) 267-7758 Get Directions Write a Review

NPPES record last updated: September 10, 2026. Verified against the NPPES registry weekly; last sync: September 27, 2026.

Record update history: Sep 10, 2026, Aug 21, 2024, Jan 5, 2024 (3 updates tracked since 2024).

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About Madison Rae Tiesenga Pa-c NPPES

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

MADISON RAE TIESENGA PA-C (NPI 1912683541) is an individual physician assistant in Grand Rapids, Michigan, licensed in Michigan (5601011952) and active in the NPI registry since June 2023. She is enrolled in Medicare PECOS, is affiliated with Spectrum Health, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1912683541

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameMADISON RAE TIESENGACredential: PA-C

Location Address4069 LAKE DR SE STE 315Grand Rapids, MI 49546-8816

Mailing Address100 Michigan St Ne # Mc845Grand Rapids, MI 49503-2560

Phone(616) 267-7758

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateJune 27, 2023

Last NPPES UpdateSeptember 10, 20263 updates tracked since enumeration

NPPES CertifiedSeptember 10, 2026

✔ NPI 1912683541 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 · 5601011952

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.

4069 LAKE DR SE STE 315, Grand Rapids, MI 49546

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Other Names 1

Former Name (1)Madison Rae Brink Pa-c

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.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

Madison Rae Tiesenga Pa-c 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 ID547612970

PECOS Enrollment IDI20240122000572

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.

Spectrum Health

Acute Care Hospitals · Grand Rapids, MI

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number230038

Location100 Michigan St NEGrand Rapids, MI 49503 · Kent 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 20

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

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