Jordan Bellmore, PA-C
Individual provider Active NPI Physician Assistant · Alpena, MI
NPI 1114512092 · NPPES record last updated Mar 3, 2021
Key facts
- NPI
- 1114512092
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601010435 (MI)
- Practice address
- 109 S 13TH Ave
Alpena, MI 49707-1609 - Phone
- (989) 356-2400
- NPI assigned
- Mar 3, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mymichigan Medical Center Alpena
Practice addresses (Care Compare)
1501 W Chisholm St
Alpena, MI 49707-1401
Hospital & facility affiliations
- Mymichigan Medical Center Alpena
- Mymichigan Medical Center Saginaw
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210408001403 | MI | Practitioner - Physician Assistant | 7719394808 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601010435 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mymichigan Medical Center Alpena | Current |
Accepting new patients | |
| Mymichigan Medical Center Alpena | Current |
Accepting new patients | |
| Mymichigan Medical Center Alpena | Past | Accepting new patients |
Locations
1501 W Chisholm St
Alpena, MI 49707
Phone (989) 356-7000
4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601010435 | MI | Yes |
Addresses
Primary practice location
109 S 13TH Ave
Alpena, MI 49707-1609
Mailing address
8775 Winding Ridge Dr
Millersburg, MI 49759
Phone (989) 733-0008
Other providers in Alpena, MI
- David M Beatty
- Jason L Beatty
- Santiago Jose Becerra
- Jack Hunter Behl
- Bella Rose Skin Care PLLC
- Josephine Bellmore
- Kiel Thomas Beltinck
- Bonnie Benac
- Julie Anne Benson
- Rene A Beraun
All providers in Alpena, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.