Active NPI
Alyson Kirkham, PA-C
- Physician Assistant
- Fort Wayne, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10003233A
- Practice address
- 7601 W Jefferson Blvd
Fort Wayne, IN 46804-4133 - Phone
- (260) 436-8686
- Fax
- (260) 436-8585
- NPI assigned
- Jan 19, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | IN | ||
| Physician Assistant | 363A00000X | 10003233A | IN | Primary |
Addresses
Primary practice location
7601 W Jefferson Blvd
Fort Wayne, IN 46804-4133
Mailing address
PO Box 2526
Fort Wayne, IN 46801-2526
Phone (866) 413-9534
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300052762 | Medicaid | IN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
701 Orthopaedic Dr
Warsaw, IN 46582-3904
Phone (800) 566-5659
701 Orthopaedic Dr
Suite 100
Warsaw, IN 46582-3905
Phone (260) 436-8686
7601 W Jefferson Blvd
Fort Wayne, IN 46804-4133
Phone (800) 566-5659
7619 W Jefferson Blvd
Fort Wayne, IN 46804-4133
7631 W Jefferson Blvd
The Imaging Center
Fort Wayne, IN 46804-4133
Phone (260) 436-7770
8450 Northwest Blvd
Indianapolis, IN 46278-1381
Phone (317) 802-2000
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 83.85 of 100
- Promoting interoperability
- 81
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10003233A | IN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fort Wayne Orthopaedics, LLC | Current | Accepting new patients | |
| Fort Wayne Orthopaedics LLC | Physician Assistant | Current | Accepting new patients |
| Orthopaedics-Indianapolis, Inc | Current | Accepting new patients | |
| Orthopaedics-Indianapolis, Inc | Current | Accepting new patients | |
| Orthopaedics-Indianapolis, Inc | Physician Assistant | Past | Accepting new patients |
Locations
306 E Maumee St
Ste 301
Angola, IN 46703
Phone (260) 665-1670
820 Smaltz Way
Auburn, IN 46706
Phone (260) 909-6430
820 Smaltz Way
Ste B
Auburn, IN 46706
Phone (260) 432-1800
303 S Main St
Ste 404A
Bluffton, IN 46714
2512 E DuPont Rd
Ste 110
Fort Wayne, IN 46825
Phone (260) 434-6076
10106 DuPont Circle Dr E
Ste 150
Fort Wayne, IN 46825
7601 W Jefferson Blvd
Fort Wayne, IN 46804
Phone 26043686864254
4900 Beaner Blvd
Gas City, IN 46933
Phone (765) 573-0725
1824 Dorchester Ct
Ste A
Goshen, IN 46526
Phone (574) 534-2548
8450 Northwest Blvd
Indianapolis, IN 46278
700 Main St
Rochester, IN 46975
Phone (574) 223-4337
701 Orthopaedic Dr
Ste 100
Warsaw, IN 46582
701 Orthopaedic Dr
Warsaw, IN 46582
Phone (260) 435-6722
701 Orthopaedic Dr
Ste 120
Warsaw, IN 46582
Interoperability endpoints
- alyson.nicodemus.p1@direct.fwortho.nextgenshare.com
Organizations & group practices 5
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.
-
- Orthopaedic Surgery Physician
- Fort Wayne, IN
- NPI 1497758429
Physician Assistant
-
- Orthopaedic Surgery Physician
- Indianapolis, IN
- NPI 1336252451
Physician Assistant
-
- Durable Medical Equipment & Medical Supplies
- Gas City, IN
- NPI 1699425082
-
- Orthopaedic Surgery Physician
- Terre Haute, IN
- NPI 1285433953
-
- Orthopaedic Surgery Physician
- Lafayette, IN
- NPI 1316210487
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Fort Wayne, IN
- NPI 1174706576
-
- General Acute Care Hospital
- Warsaw, IN
- NPI 1164475711
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679961600000",
"number": "1497345086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2526",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468012526",
"telephone_number": "866-413-9534",
"fax_number": "260-407-4428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7601 W JEFFERSON BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468044133",
"telephone_number": "260-436-8686",
"fax_number": "260-436-8585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRKHAM",
"first_name": "ALYSON",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-19",
"last_updated": "2023-03-28",
"certification_date": "2023-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IN",
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IN",
"license": "10003233A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300052762",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "email",
"affiliation": "N",
"address_1": "9326 S 450 W",
"city": "South Whitley",
"state": "IN",
"country_code": "US",
"postal_code": "467879758",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.