Individual provider Active NPI

Mandy Jo Bates, PA-C

  • Surgical Physician Assistant
  • Kalamazoo, MI
National Provider Identifier
1194772384
Registry record updated Dec 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
5601004616 Issued in MI
Practice address
1535 Gull Rd
Suite 020
Kalamazoo, MI 49048-1650
Phone
(269) 381-4577
NPI assigned
May 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 5601004616 MI Primary

Addresses

Primary practice location

1535 Gull Rd
Suite 020
Kalamazoo, MI 49048-1650

Mailing address

1535 Gull Rd
Suite 020
Kalamazoo, MI 49048
Phone (269) 381-4577

Other names 1

  • Mandy Jo Lentz Other name

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
I20091002000438 MI Practitioner - Physician Assistant 5799821898 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension Medical Group PromedGroup PAC ID 7315856077, 255 clinicians

Practice addresses (Care Compare)

1521 Gull Rd
Kalamazoo, MI 49048-1640
Phone (269) 226-5165

7901 Angling Rd
Portage, MI 49024-0714

Hospital & facility affiliations

  • Borgess Medical Center Hospital, Kalamazoo, MI, CCN 230117

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601004616MIMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Promed Healthcare CurrentSince Oct 22, 2018 Accepting new patients
Ascension Borgess Hospital Past Accepting new patients
Ascension Medical Group Promed Past Accepting new patients

Locations

551 Linn St
Allegan, MI 49010
Phone (269) 686-5800

1535 Gull Rd
Ste 020
Kalamazoo, MI 49048
Phone (269) 381-4577

1535 Gull Rd
Ste 20
Kalamazoo, MI 49048
Phone (269) 381-4577

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

Organizations & group practices 3

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 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": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1230595200000",
    "number": "1194772384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 GULL RD",
            "address_2": "SUITE 020",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "49048",
            "telephone_number": "269-381-4577",
            "fax_number": "269-381-6409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1535 GULL RD",
            "address_2": "SUITE 020",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481650",
            "telephone_number": "269-381-4577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BATES",
        "first_name": "MANDY",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-31",
        "last_updated": "2008-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601004616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANDY",
            "last_name": "LENTZ",
            "middle_name": "JO",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.