NPIMap

Individual provider Active NPI

Alyssa Raye Carney

  • Physician Assistant
  • South Bend, IN
National Provider Identifier
1316699879
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
100 Navarre PL Ste 4440
South Bend, IN 46601-1171
Phone
(574) 647-5300
Fax
(574) 647-5305
NPI assigned
Jan 25, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 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

100 Navarre PL Ste 4440
South Bend, IN 46601-1171

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other practice location 1

900 I St
LA Porte, IN 46350-5533
Phone (219) 324-1700

Other practice location 2

3301 County Road 6 E
Elkhart, IN 46514-7673
Phone (574) 264-9635

Other practice location 3

5314 Lincolnway E
Mishawaka, IN 46544-4249
Phone (574) 256-9032

Other identifiers 1

IdentifierTypeStateIssuer
300062949MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241231000374 MO Practitioner - Physician Assistant 5890174437 Reassigns benefits to 1 organization
I20250531000041 KS Practitioner - Physician Assistant 5890174437 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
Group practices
Orthopedic Health of Kansas City PCGroup PAC ID 3375508443, 47 clinicians

Practice addresses (Care Compare)

10900 W 86TH St
Lenexa, KS 66214-1634
Phone (816) 561-3003

1950 Diamond Pkwy
Suite 100
Kansas City, MO 64116-4329

Hospital & facility affiliations

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: orthopedichealthofkansascity.alyssacarney@151220.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 and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1643068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682640000000",
    "number": "1316699879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NAVARRE PL STE 4440",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011171",
            "telephone_number": "574-647-5300",
            "fax_number": "574-647-5305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 I St",
            "address_purpose": "LOCATION",
            "city": "LA Porte",
            "state": "IN",
            "postal_code": "463505533",
            "country_code": "US",
            "telephone_number": "219-324-1700",
            "fax_number": "219-324-1602",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3301 County Road 6 E",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465147673",
            "country_code": "US",
            "telephone_number": "574-264-9635",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5314 Lincolnway E",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465444249",
            "country_code": "US",
            "telephone_number": "574-256-9032",
            "fax_number": "574-256-9049",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARNEY",
        "first_name": "ALYSSA",
        "middle_name": "RAYE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-25",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300062949",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.