Individual provider Active NPI

Alyxandria Kathryn Andrus, PA-C

  • Physician Assistant
  • Green Bay, WI
National Provider Identifier
1073999397
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2605 Development Dr
Green Bay, WI 54311-4240
Phone
(920) 288-8240
Fax
(920) 857-1488
NPI assigned
Aug 10, 2015
Last updated
Apr 21, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

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 WI Primary

Addresses

Primary practice location

2605 Development Dr
Green Bay, WI 54311-4240

Mailing address

1035 Kepler Dr
Green Bay, WI 54311-8320
Phone (920) 490-9046

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20151019002337 WI Practitioner - Physician Assistant 7810206661 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baycare Clinic LLPGroup PAC ID 4385554328, 197 clinicians

Practice addresses (Care Compare)

2605 Development Dr
Green Bay, WI 54311-4240
Phone (920) 288-8240

2845 Greenbrier Rd
Green Bay, WI 54311-6519

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.21 of 100Reported as group
Quality
78.54
Promoting interoperability
100
Improvement activities
40
Cost
75.5

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baycare Clinic LLP CurrentSince Sep 15, 2015 Accepting new patients
Baycare Clinic LLP CurrentSince Sep 15, 2015 Accepting new patients

Locations

1035 Kepler Dr
Green Bay, WI 54311

2581 Development Dr
Green Bay, WI 54311
Phone (920) 347-0400

2605 Development Dr
Green Bay, WI 54311
Phone (920) 288-8240

2845 Greenbrier Rd
Green Bay, WI 54311
Phone (920) 288-3388

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

1500 Arbor Way
Kaukauna, WI 54130
Phone (877) 229-2273

719 Doctors Ct
Oshkosh, WI 54901
Phone (920) 235-0066

Organizations & group practices 2

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

Hospital & facility affiliations 1

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": "1439164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1073999397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 KEPLER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118320",
            "telephone_number": "920-490-9046",
            "fax_number": "920-405-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 DEVELOPMENT DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543114240",
            "telephone_number": "920-288-8240",
            "fax_number": "920-857-1488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRUS",
        "first_name": "ALYXANDRIA",
        "middle_name": "KATHRYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-10",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.