JAMES DERNOCOEUR PA NPI 1083609374

NPI Information

NPI: 1083609374
Provider Name: JAMES DERNOCOEUR, PA
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

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

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 Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), 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
1	363A00000X	Physician Assistant		5601002553	MICHIGAN	No
2	363AM0700X	Physician Assistant	Medical	5601002553	MICHIGAN	Yes

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
1	0P38340023	MEDICARE OSCAR/CERTIFICATION
2	D16091091	MEDICARE OSCAR/CERTIFICATION	MICHIGAN
3	075100129	MEDICARE OSCAR/CERTIFICATION	WISCONSIN
4	970004371	OTHER	MICHIGAN	RAILROAD MEDICARE
5	S42668	MEDICARE UPIN	MICHIGAN

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: 11/14/2023

NPI Synchronization or Removal

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