Individual provider Active NPI

Brittany Manners Immink, PA

  • Physician Assistant
  • Portage, MI
National Provider Identifier
1194081307
Registry record updated Jul 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
7775 Angling Rd
Portage, MI 49024-7427
Phone
(269) 324-8670
NPI assigned
Apr 2, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 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 MI Primary

Addresses

Primary practice location

7775 Angling Rd
Portage, MI 49024-7427

Mailing address

7775 Angling Rd
Portage, MI 49024-7427
Phone (269) 324-8670

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
I20120917000689 MI Practitioner - Physician Assistant 8224286224 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ascension Medical Group PromedGroup PAC ID 7315856077, 255 clinicians

Practice addresses (Care Compare)

7775 Angling Rd
Portage, MI 49024-7427
Phone (269) 321-7120

7901 Angling Rd
Portage, MI 49024-0714

Hospital & facility affiliations

  • Borgess Medical Center Hospital, Kalamazoo, MI, CCN 230117
  • Bronson Methodist Hospital Hospital, Kalamazoo, MI, CCN 230017
  • Beacon Plainwell Long-term care hospital, Plainwell, MI, CCN 232034

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group Promed CurrentSince Jul 5, 2012 Accepting new patients
Promed Healthcare CurrentSince Jul 5, 2012 Accepting new patients

Locations

7775 Angling Rd
Portage, MI 49024
Phone (269) 321-7120

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

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 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": "1333324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784764800000",
    "number": "1194081307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7775 ANGLING RD",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490247427",
            "telephone_number": "269-324-8670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7775 ANGLING RD",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490247427",
            "telephone_number": "269-324-8670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMMINK",
        "first_name": "BRITTANY",
        "middle_name": "MANNERS",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-02",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

Verify at the official NPI Registry.