Individual provider Active NPI

Ava Madison Ponto, PA-C

  • Physician Assistant
  • Munster, IN
National Provider Identifier
1255084257
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10003572A Issued in IN
Practice address
9250 Columbia Ave Ste 2E
Munster, IN 46321-3530
Phone
(219) 595-0043
NPI assigned
Jan 31, 2022
Last updated
May 3, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 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
Physician Assistant 363A00000X 10003572A IN Primary

Addresses

Primary practice location

9250 Columbia Ave Ste 2E
Munster, IN 46321-3530

Mailing address

9250 Columbia Ave Ste 2E
Munster, IN 46321-3530
Phone (219) 595-0043

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20220609000974 IN Practitioner - Physician Assistant 2264810886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nwi Clarity ClinicGroup PAC ID 5991082976, 32 clinicians

Practice addresses (Care Compare)

9250 Columbia Ave
Suite 2E
Munster, IN 46321-3530
Phone (219) 595-0043

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10003572AINMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: ccin.ava.ponto@138327.advancedmd-direct.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1255084257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9250 COLUMBIA AVE STE 2E",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463213530",
            "telephone_number": "219-595-0043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9250 COLUMBIA AVE STE 2E",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463213530",
            "telephone_number": "219-595-0043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONTO",
        "first_name": "AVA",
        "middle_name": "MADISON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-31",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10003572A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Munster, IN

Sources for this page

Verify at the official NPI Registry.