Alexa Dillin, PA-C
Individual provider Active NPI Surgical Physician Assistant · Davenport, IA
NPI 1265048946 · NPPES record last updated Jan 9, 2024
Key facts
- NPI
- 1265048946
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- 085.009148 (IL)
- Practice address
- 1320 W Lombard St
Davenport, IA 52804-2029 - Phone
- (641) 494-4486
- NPI assigned
- Sep 18, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Morrison Community Hospital District
Practice addresses (Care Compare)
303 N Jackson St
Morrison, IL 61270-3042
Phone (815) 772-4003
Hospital & facility affiliations
- Morrison Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA, IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220321000530 | IA | Practitioner - Physician Assistant | 8527453026 | Reassigns benefits to 1 organization |
| I20230519002606 | IL | Practitioner - Physician Assistant | 8527453026 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 112596 | IA | MD | Physician Assistant |
| 085.009148 | IL | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesis Health System | Current |
Accepting new patients | |
| Morrison Community Hospital District | Current |
Accepting new patients | |
| Genesis Health System | Current |
Accepting new patients |
Locations
865 Lincoln Rd
Ste 100
Bettendorf, IA 52722
Phone (563) 355-1000
4700 E 56th St
Ste 100
Davenport, IA 52807
Phone (563) 383-2667
1227 E Rusholme St
Davenport, IA 52803
Phone (563) 324-8160
657 W Lincolnway
Morrison, IL 61270
Phone (815) 772-4003
303 N Jackson St
Morrison, IL 61270
Phone (815) 772-4003
Interoperability endpoints
- alexadillin@mchospital.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 112596 | IA | |
| Surgical Physician Assistant | 363AS0400X | 085.009148 | IL | Yes |
Addresses
Primary practice location
1320 W Lombard St
Davenport, IA 52804-2029
Mailing address
1608 Central Ave
Bettendorf, IA 52722-6039
Other practice location 1
303 N Jackson St
Morrison, IL 61270-3042
Phone (815) 772-5505
Other names
- Alexa Wasicek
Other providers in Davenport, IA
- David W.R. Dierks
- Dietrich Chiropractic PC
- L. Anthony Dietrich
- Carol M. Dietsch
- James Stevan Digman
- Ronald A Diotte
- Eric J Dippel
- Kelly Dirksen
- Amanda Disch
- Callyn Rose Dittmar
All providers in Davenport, IA · Surgical Physician Assistant in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.