Micah Lynn Ann Clutter

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-007766 Issued in IL

Practice address

324 Roxbury Rd
Rockford, IL 61107-5090

Phone

(815) 398-9491

Fax

(815) 381-7498

NPI assigned

Mar 25, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopaedic Associates of Wisconsin SCGroup PAC ID 1052200953, 106 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Orthopaedic Associates of Wisconsin, SC

  • Orthopaedic Surgery Physician
  • Pewaukee, WI
  • NPI 1689656951
  Medicare reassignment Care Compare group
• Orthopaedic Associates of Wisconsin SC

  • Orthopaedic Surgery Physician
  • Mukwonago, WI
  • NPI 1720433790
  NPD

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

• Prohealth Waukesha Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Waukesha, WI
  • NPI 1629056890
  Care Compare affiliation

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

{
    "created_epoch": "1585094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1053948521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 78534",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788534",
            "telephone_number": "815-398-9491",
            "fax_number": "815-381-7498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 ROXBURY RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075090",
            "telephone_number": "815-398-9491",
            "fax_number": "815-381-7498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLUTTER",
        "first_name": "MICAH",
        "middle_name": "LYNN ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-25",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-007766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew C. Clayton, MSW, LSW
• Jordan Cleary, APRN
• Michelle Lee Cleveland, NP
• Clifton Health Systems LLC
• Clifton Health Systems, LLC
• Clyde Medical Suppliers LLC
• Aaron G. Coates, MD
• Maria Cobio, PHARM.D.
• Kai Codner, DDS
• Maria E Coffman, PT

• Physician Assistant in Rockford, IL
• Providers in Rockford, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.