JAMES DERNOCOEUR PA NPI 1083609374

NPI Information

  • NPI: 1083609374
  • Provider Name: JAMES DERNOCOEUR, PA
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 200 JEFFERSON AVE SE
    GRAND RAPIDS, MI
    ZIP 49503
  • Phone: (800) 968-6866

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NPI Details

James Dernocoeur, PA is a medical physician assistant in Grand Rapids, MI. James Dernocoeur, PA NPI is 1083609374. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

200 JEFFERSON AVE SE
GRAND RAPIDS, MI
ZIP 49503-502
Phone: (800) 968-6866

The NPI 1083609374 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 9/13/2005 and was last updated on 8/11/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363A00000XPhysician Assistant5601002553MICHIGANNo
2363AM0700XPhysician AssistantMedical5601002553MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10P38340023MEDICARE OSCAR/CERTIFICATION
2D16091091MEDICARE OSCAR/CERTIFICATIONMICHIGAN
3075100129MEDICARE OSCAR/CERTIFICATIONWISCONSIN
4970004371OTHERMICHIGANRAILROAD MEDICARE
5S42668MEDICARE UPINMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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