Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lisa Jane Ealy Cavanaugh

Individual provider Physician Assistant · NPI 1245658657

Lisa Jane Ealy Cavanaugh is a Physician Assistant in Grand Rapids, Michigan. Qualified in 2013, 13 years ago. Practices with Spectrum Health Primary Care Partners, a 2,303-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
13
Licensed in
MI
In the registry since
2014
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Practice location Address checks out

100 Michigan St NE Ste A721
Grand Rapids, MI 49503-2560
Phone: (616) 391-3139
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601006950 (MI)

Record details

NPI number1245658657
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedApril 2, 2014
Last updated in NPPESFebruary 22, 2021
Certification dateFebruary 22, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Spectrum Health Primary Care Partners — 2303 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Grand Rapids