Individual provider Active NPI

Austin D Hickok, PA-C

  • Physician Assistant
  • Portage, MI
National Provider Identifier
1265021042
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
7901 Angling Rd
Portage, MI 49024-0714
Phone
(269) 324-8600
NPI assigned
Jan 15, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

7901 Angling Rd
Portage, MI 49024-0714

Mailing address

7901 Angling Rd
Portage, MI 49024-0714
Phone (269) 324-8600

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
I20210608003172 MI Practitioner - Physician Assistant 9133529464 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
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)

7901 Angling Rd
Portage, MI 49024-0714

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Promed Healthcare CurrentSince Jun 20, 2021 Accepting new patients
Ascension Medical Group Promed CurrentSince Jun 20, 2021 Accepting new patients
Ascension Medical Group Promed Past Accepting new patients

Locations

1717 Shaffer St
Ste 2
Kalamazoo, MI 49048

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

8450 N 32nd St
Richland, MI 49083
Phone (269) 226-2500

1241 W Broadway St
Three Rivers, MI 49093
Phone (269) 273-9539

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": "1610668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1265021042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7901 ANGLING RD",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240714",
            "telephone_number": "269-324-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7901 ANGLING RD",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240714",
            "telephone_number": "269-324-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKOK",
        "first_name": "AUSTIN",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-15",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

Verify at the official NPI Registry.