NPIMap

Individual provider Active NPI

Alexis Mackenzie Hannah

  • Physician Assistant
  • Lima, OH
National Provider Identifier
1255084679
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1003 Bellefontaine Ave Ste 200
Lima, OH 45804-1803
Phone
(419) 224-5915
Fax
(419) 224-5918
NPI assigned
Jan 27, 2022
Last updated
Dec 5, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

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 Primary

Addresses

Primary practice location

1003 Bellefontaine Ave Ste 200
Lima, OH 45804-1803

Mailing address

10810 Reservoir Rd
Ada, OH 45810-9213

Other practice location 1

4405 N Holland Sylvania Rd
Toledo, OH 43623-3529
Phone (567) 803-0426

Other names 1

  • Alexis Mackenzie Amburgey Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220311001475 OH Practitioner - Physician Assistant 0345635280 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1001 Bellefontaine Ave
Lima, OH 45804-2800
Phone (419) 998-4575

140 Fox Rd
Suite 103 1/2
Van Wert, OH 45891-3400
Phone (419) 232-6700

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lima Memorial Professional Corporation CurrentSince Dec 12, 2023 Accepting new patients
Lima Memorial Professional Corporation CurrentSince Dec 12, 2023 Accepting new patients
Greater Toledo Urgent Cares, LLC. CurrentSince Jan 26, 2022 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

L3982
Columbus, OH 43260

1001 Bellefontaine Ave
Lima, OH 45804
Phone (419) 228-3335

1003 Bellefontaine Ave
Ste 200
Lima, OH 45804
Phone (419) 224-5914

4405 N Holland Sylvania Rd
Toledo, OH 43623
Phone (910) 297-7270

Organizations & group practices 5

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.

Hospital & facility affiliations 4

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": "1643241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1255084679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10810 RESERVOIR RD",
            "city": "ADA",
            "state": "OH",
            "postal_code": "458109213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 BELLEFONTAINE AVE STE 200",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458041803",
            "telephone_number": "419-224-5915",
            "fax_number": "419-224-5918"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4405 N Holland Sylvania Rd",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436233529",
            "country_code": "US",
            "telephone_number": "567-803-0426",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANNAH",
        "first_name": "ALEXIS",
        "middle_name": "MACKENZIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-27",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEXIS",
            "last_name": "AMBURGEY",
            "middle_name": "MACKENZIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lima, OH

Sources for this page

Verify at the official NPI Registry.