Individual provider Active NPI

Amy Juodawlkis, PA-C

  • Physician Assistant
  • Kalamazoo, MI
National Provider Identifier
1457301558
Registry record updated Dec 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004196 Issued in MI
Practice address
1535 Gull Rd
MSB 015
Kalamazoo, MI 49048-1650
Phone
(269) 226-6933
Fax
(269) 226-6949
NPI assigned
May 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2007

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 5601004196 MI Primary

Addresses

Primary practice location

1535 Gull Rd
MSB 015
Kalamazoo, MI 49048-1650

Mailing address

1535 Gull Rd
MSB 015
Kalamazoo, MI 49048-1650
Phone (269) 226-6933

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
I20050124000020 MI Practitioner - Physician Assistant 2466402961 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension Medical Group PromedGroup PAC ID 7315856077, 255 clinicians

Practice addresses (Care Compare)

7775 Angling Rd
Portage, MI 49024-7427
Phone (269) 321-7120

7901 Angling Rd
Portage, MI 49024-0714

Hospital & facility affiliations

  • Borgess Medical Center Hospital, Kalamazoo, MI, CCN 230117

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601004196MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Promed Healthcare CurrentSince Oct 10, 2011 Accepting new patients
Ascension Medical Group Promed CurrentSince Oct 10, 2011 Accepting new patients
Ascension Borgess Hospital CurrentSince Jun 11, 2023 Accepting new patients
Ascension Borgess Hospital CurrentSince Jun 11, 2023 Accepting new patients
Kalamazoo Acute Care Specialists PLC Past Accepting new patients
Kalamazoo Emergency Associates, PLC Past Accepting new patients
Ascension Medical Group Promed Past Accepting new patients

Locations

842 Columbia Ave E
Ste 2
Battle Creek, MI 49014
Phone (269) 753-1710

1535 Gull Rd
Ste 15
Kalamazoo, MI 49048
Phone (269) 226-6933

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

7775 Angling Rd
Portage, MI 49024
Phone (269) 321-7120

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

Organizations & group practices 7

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197936000000",
    "number": "1457301558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 GULL RD",
            "address_2": "MSB 015",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481650",
            "telephone_number": "269-226-6933",
            "fax_number": "269-226-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1535 GULL RD",
            "address_2": "MSB 015",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481650",
            "telephone_number": "269-226-6933",
            "fax_number": "269-226-6949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUODAWLKIS",
        "first_name": "AMY",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2007-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.