Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Shelby Petersen

Individual provider Physician Assistant · NPI 1245006709

Shelby Petersen is a Physician Assistant in Grand Rapids, Michigan. Graduated from Wayne State University School of Medicine in 2024, 2 years ago. Practices with Ecs Western Michigan PC, a 201-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
2
Trained at
Wayne State University School of Medicine
Licensed in
MI
In the registry since
2023
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

4100 Embassy Dr SE Ste 400
Grand Rapids, MI 49546-2416
Phone: (822) 061-6988
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601012426 (MI)

Record details

NPI number1245006709
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedNovember 27, 2023
Last updated in NPPESJuly 22, 2024
Certification dateJuly 17, 2024

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolWAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Graduated 2024 (2 years in practice)
Group practice Ecs Western Michigan Pc — 201 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician.

Colleagues at Ecs Western Michigan PC

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 201 clinicians in the practice; 12 are shown here.

Other providers in Grand Rapids