Unknown Individual – Physician Assistant, NPI 1174544696
Physician Assistant
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
1260 AJIJAAK AVE
PETOSKEY, MI 497708330
Phone: (231) 242-1700
Fax: (231) 242-1717
Type: Mailing
Petoskey Bridal, Lears Road, Bear Creek Township, Emmet County, Michigan, 49770, United States
PETOSKEY, MI 497709252
Phone: (231) 242-1700
Fax: (231) 242-1717
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $15.
Total Amount is formed as General ($15) + Research ($0) + Ownership ($0) = $15.
Last reported payment date: 2023-11-29 • Largest payer in this snapshot: Dexcom, Inc. ($15).
Total Amount
$15
General + Research + Ownership
Payments
1
Total payment records
General Amount
$15
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-11-29
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Dexcom, Inc. | $15 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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 |
|---|---|---|---|---|
| 83036 | Hemoglobin a1c level | 91 | 49 | $0 |
| 82962 | Blood glucose (sugar) test performed by hand-held instrument | 83 | 36 | $0 |
| 82044 | Urine microalbumin (protein) analysis | 31 | 26 | $0 |
| 81003 | Automated urinalysis test | 30 | 25 | $0 |
| 96372 | Injection of drug or substance under skin or into muscle | 17 | 12 | $0 |
Insurance plans in this area (ZIP 49770)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | MI | 83036 | Hemoglobin A1C level | 101 | 55 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Mental Health Counselor | MI | |
| Clinical Social Worker | MI | |
| Mental Health Counselor | MI | |
| Family Practice | MI | |
| Clinical Social Worker | MI | |
| Clinical Psychologist | MI | |
| Pediatric Medicine | MI | |
| Clinical Social Worker | MI | |
| Family Practice | MI | |
| Family Practice | MI |
Reviews
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