Cassandra Dawn Ault, PA
Individual provider Active NPI Physician Assistant · Saint Joseph, MI
NPI 1487315404 · NPPES record last updated Aug 15, 2023
Key facts
- NPI
- 1487315404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601011613 (MI)
- Practice address
- 1234 Napier Ave
Saint Joseph, MI 49085-2112 - Phone
- (269) 985-4632
- Fax
- (269) 985-4523
- NPI assigned
- Jan 2, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lakeland Medical Practices
Practice addresses (Care Compare)
1234 Napier Ave
Saint Joseph, MI 49085-2112
Phone (269) 983-8300
31 N Saint Joseph Ave
Niles, MI 49120-2207
Phone (269) 687-1436
3950 Hollywood Rd
Saint Joseph, MI 49085-9151
Hospital & facility affiliations
- Lakeland Hospital, St Joseph
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- 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 |
|---|---|---|---|---|
| I20230216002084 | MI | Practitioner - Physician Assistant | 3577935766 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601011613 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeland Medical Practices | Current |
Accepting new patients |
Locations
100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242
3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990
1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941
Interoperability endpoints
- cault1268370@epic00.corewelldirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | 5601011613 | MI | Yes |
Addresses
Primary practice location
1234 Napier Ave
Saint Joseph, MI 49085-2112
Mailing address
1234 Napier Ave
Saint Joseph, MI 49085-2112
Phone (269) 985-4632
Other practice location 1
3000 Arlington Ave # MS 1027
Toledo, OH 43614-2595
Phone (419) 530-5408
Other practice location 2
100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560
Phone (616) 486-6790
Other names
- Cassandra Dawn Misiewicz
Other providers in Saint Joseph, MI
- Assured Care Assisted Living, LLC
- Dania Atallah
- Reyan Atassi
- Jessica Atkins
- Corey Aukerman
- Julia E Austen
- Avalon Consulting, Inc.
- Axon Psychology Group, PC
- Margaretha Baestaens
- Bidisha Bagchi
All providers in Saint Joseph, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2023. 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.