Individual provider Active NPI

Sarah Dixcy Carlisle, P.A.

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1104062066
Registry record updated Jan 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005460 Issued in MI
Practice address
1000 E Paris Ave SE Ste 260
Grand Rapids, MI 49546-8313
Phone
(616) 957-9237
Fax
(616) 957-1013
NPI assigned
Dec 26, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2020

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 5601005460 MI Primary

Addresses

Primary practice location

1000 E Paris Ave SE Ste 260
Grand Rapids, MI 49546-8313

Mailing address

PO Box 1682
Grand Rapids, MI 49501-1682
Phone (616) 774-5221

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20090319000647 MI Practitioner - Physician Assistant 3072670967 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Paris Internal Medicine Associates PCGroup PAC ID 9537118914, 6 clinicians
Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians
Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians

Practice addresses (Care Compare)

1000 E Paris Ave SE
Suite 260
Grand Rapids, MI 49546-8313
Phone (616) 954-9260

5060 Cascade Rd
Suite a
Grand Rapids, MI 49546-3808

5060 Cascade Rd SE
Suite a
Grand Rapids, MI 49546-3808

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601005460MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Rapids Addiction Medicine Specialists PC Past Accepting new patients
Hospitalists of West Michigan PC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: scarlisle174716@epic00.corewelldirect.org

Organizations & group practices 4

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 3

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": "1230249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579737600000",
    "number": "1104062066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1682",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495011682",
            "telephone_number": "616-774-5221",
            "fax_number": "616-774-5391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E PARIS AVE SE STE 260",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468313",
            "telephone_number": "616-957-9237",
            "fax_number": "616-957-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLISLE",
        "first_name": "SARAH",
        "middle_name": "DIXCY",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-26",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.