NPIMap

Individual provider Active NPI

Marisa Lynn Rogers

  • Physician Assistant
  • Manistee, MI
National Provider Identifier
1013615749
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1465 E Parkdale Ave
Manistee, MI 49660-9709
Phone
(616) 988-8220
NPI assigned
Feb 22, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1465 E Parkdale Ave
Manistee, MI 49660-9709

Mailing address

4100 Embassy Dr SE Ste 400
Grand Rapids, MI 49546-2416
Phone (616) 975-1845

Other practice location 1

416 Connable Ave
Petoskey, MI 49770-2212
Phone (800) 248-6777

Other practice location 2

748 S Main St
Cheboygan, MI 49721-2220
Phone (231) 487-2490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230317000669 MI Practitioner - Physician Assistant 1658745435 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Interlochen Emergency Group PCGroup PAC ID 3577918606, 49 clinicians

Practice addresses (Care Compare)

1105 6TH St
Traverse City, MI 49684-2345
Phone (231) 935-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.79 of 100Reported as group
Quality
79.33
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
97.48 of 100Reported as group
Quality
89.26
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Interlochen Emergency Group, P.C. Physician Assistant CurrentSince Oct 4, 2025 Accepting new patients

Locations

224 Park Ave
Frankfort, MI 49635
Phone (231) 352-2200

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1013615749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 EMBASSY DR SE STE 400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462416",
            "telephone_number": "616-975-1845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 E PARKDALE AVE",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496609709",
            "telephone_number": "616-988-8220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "416 Connable Ave",
            "address_purpose": "LOCATION",
            "city": "Petoskey",
            "state": "MI",
            "postal_code": "497702212",
            "country_code": "US",
            "telephone_number": "800-248-6777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "748 S Main St",
            "address_purpose": "LOCATION",
            "city": "Cheboygan",
            "state": "MI",
            "postal_code": "497212220",
            "country_code": "US",
            "telephone_number": "231-487-2490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "MARISA",
        "middle_name": "LYNN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-22",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manistee, MI

Sources for this page

Verify at the official NPI Registry.