CONNIE M ANDERSON (PA-C) – Physician Assistant, NPI 1124012919
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
6,066 PHYSICIAN ASSISTANT in MI
Provider Addresses for CONNIE M ANDERSON (PA-C)
3434 Rivertown Point Ct SW
Grandville, MI 494183076
Phone: (616) 257-3344
Fax: (616) 257-1491
Type: Location
6150 Northland Drive
Rockford, MI 49341
Phone: (616) 942-9343
Fax: (616) 942-2538
Type: Location
3290 N WELLNESS DR STE 240
HOLLAND, MI 494247261
Phone: (616) 395-9379
Fax: (616) 820-1457
Type: Mailing
East Beltline Avenue Northeast, Grand Rapids, Kent County, Michigan, 49547, United States
GRAND RAPIDS, MI 495256046
Phone: (616) 942-9343
Fax: (616) 942-2538
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 103 Open Payments records for all available years, with a total value of $2,379.
Total Amount is formed as General ($2,379) + Research ($0) + Ownership ($0) = $2,379.
Last reported payment date: 2024-12-18 • Largest payer in this snapshot: Novartis Pharmaceuticals Corporation ($395).
Total Amount
$2,379
General + Research + Ownership
Payments
103
Total payment records
General Amount
$2,379
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-18
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-03-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050316000420 | I | Physician Assistant | MI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 225 | 49 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 164 | 145 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 87 | 75 | $0 |
| 11102 | Biopsy of related skin growth, first growth | 73 | 70 | $0 |
| 11103 | Biopsy of related skin growth, each additional growth | 38 | 21 | $0 |
Insurance plans in this area (ZIP 49418)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | MI | 17003 | Destruction of 2-14 skin growths | 267 | 53 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| D E R M A T O L O G Y | MI | |
| D E R M A T O L O G Y | MI | |
| Physician Assistant | MI | |
| D E R M A T O L O G Y | IA | |
| Physician Assistant | MI | |
| D E R M A T O L O G Y | MI | |
| D E R M A T O L O G Y | MI | |
| Micrographic Dermatologic Surgery (Mds), Dermatology | MI | |
| - | MI | |
| Physician Assistant | MI |
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