Individual provider Active NPI

Alexandra N Nelson, PA-C

  • Physician Assistant
  • Green Bay, WI
National Provider Identifier
1164096293
Registry record updated Nov 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601010487 Issued in MI
Practice address
725 S Webster Ave
Green Bay, WI 54301-3500
Phone
(920) 433-7995
NPI assigned
May 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5440-23 WI
Physician Assistant 363A00000X 5601010487 MI Primary

Addresses

Primary practice location

725 S Webster Ave
Green Bay, WI 54301-3500

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222

Other practice location 1

610 S Lincoln Rd
Escanaba, MI 49829-1215
Phone (906) 786-6488

Other practice location 2

2820 Roosevelt Rd
Marinette, WI 54143-3834
Phone (715) 735-5225

Other practice location 3

212 E B St
Iron Mountain, MI 49801-3411
Phone (906) 776-9040

Other practice location 4

440 Woodward Ave
Iron Mountain, MI 49801-4631
Phone (906) 776-9040

Other identifiers 1

IdentifierTypeStateIssuer
1182339OtherNATIONAL COMMISSION ON CERT OF PHYSICIAN ASSISTANTS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210706002331 MI Practitioner - Physician Assistant 2062814635 Reassigns benefits to 1 organization
I20210813000081 WI Practitioner - Physician Assistant 2062814635 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bellin Memorial Hospital IncGroup PAC ID 8820900749, shared by 10 NPIs, 685 clinicians

Practice addresses (Care Compare)

2020 S Webster Ave
Accounting
Green Bay, WI 54301-3505

212 E B St
Bellin Health
Iron Mountain, MI 49801-3411
Phone (906) 776-9040

440 Woodward Ave
Iron Mountain, MI 49801-4631
Phone (906) 776-9040

610 S Lincoln Rd
Bellin Health
Escanaba, MI 49829-1215
Phone (906) 786-6488

744 S Webster Ave
Green Bay, WI 54301-3505

Hospital & facility affiliations

  • Dickinson County Memorial Hospital Hospital, Iron Mountain, MI, CCN 230055
  • Osf St Francis Hospital and Medical Group Hospital, Escanaba, MI, CCN 231337
  • Marshfield Medical Center Hospital, Iron Mountain, MI, CCN 231342

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601010487MIMDPhysician Assistant
5440-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Oconto Hospital & Medical Center Inc CurrentSince Nov 21, 2022 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Jun 1, 2021 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Nov 21, 2022 Accepting new patients
Bellin Memorial Hospital CurrentSince Jul 5, 2021 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Jun 1, 2021 Accepting new patients
Bellin Memorial Hospital Inc Past Accepting new patients

Locations

610 S Lincoln Rd
Escanaba, MI 49829
Phone (906) 786-6488

440 Woodward Ave
Iron Mountain, MI 49801
Phone (906) 776-9040

212 E B St
Iron Mountain, MI 49801
Phone (906) 774-2990

725 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-7995

744 S Webster Ave
Fl 7
Green Bay, WI 54301

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

Interoperability endpoints

  • Direct secure messaging: anelson925987@direct.emplifyhealth.org
  • Direct secure messaging: anelson307743@direct.thedacare.org

Organizations & group practices 9

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 2

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": "1620864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1164096293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013500",
            "telephone_number": "920-433-7995"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "610 S Lincoln Rd",
            "address_purpose": "LOCATION",
            "city": "Escanaba",
            "state": "MI",
            "postal_code": "498291215",
            "country_code": "US",
            "telephone_number": "906-786-6488",
            "fax_number": "906-786-6409",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2820 Roosevelt Rd",
            "address_purpose": "LOCATION",
            "city": "Marinette",
            "state": "WI",
            "postal_code": "541433834",
            "country_code": "US",
            "telephone_number": "715-735-5225",
            "fax_number": "715-735-5388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "212 E B St",
            "address_purpose": "LOCATION",
            "city": "Iron Mountain",
            "state": "MI",
            "postal_code": "498013411",
            "country_code": "US",
            "telephone_number": "906-776-9040",
            "fax_number": "906-774-7279",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "440 Woodward Ave",
            "address_purpose": "LOCATION",
            "city": "Iron Mountain",
            "state": "MI",
            "postal_code": "498014631",
            "country_code": "US",
            "telephone_number": "906-776-9040",
            "fax_number": "906-774-7279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "ALEXANDRA",
        "middle_name": "N",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-13",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "5440-23",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL COMMISSION ON CERT OF PHYSICIAN ASSISTANTS",
            "identifier": "1182339",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.