Marisa Karcz Claysen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601007181 Issued in MI

Practice address

725 S Adams Rd Ste 266
Birmingham, MI 48009-6999

Phone

(248) 252-2829

Fax

(248) 633-8825

NPI assigned

Sep 16, 2014

Last updated

Jan 2, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Marisa Karcz Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Fundamental Health, PLLC

  • Physician Assistant
  • Birmingham, MI
  • NPI 1699310300
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577923200000",
    "number": "1457752974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1769 BOWERS ST",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480096886",
            "telephone_number": "248-252-2829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 S ADAMS RD STE 266",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480096999",
            "telephone_number": "248-252-2829",
            "fax_number": "248-633-8825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 N Pond Dr Ste 6",
            "address_purpose": "LOCATION",
            "city": "Walled Lake",
            "state": "MI",
            "postal_code": "483903080",
            "country_code": "US",
            "telephone_number": "248-252-2829",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLAYSEN",
        "first_name": "MARISA",
        "middle_name": "KARCZ",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-16",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "contact@marisa-pac.com",
            "affiliation": "N",
            "address_1": "725 S Adams Rd Ste 266",
            "city": "Birmingham",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480096999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARISA",
            "last_name": "KARCZ",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physician Assistant in Birmingham, MI
• Providers in Birmingham, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.