Individual provider Active NPI

Alyson Kirkham, PA-C

  • Physician Assistant
  • Fort Wayne, IN
National Provider Identifier
1497345086
Registry record updated Mar 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10003233A Issued in IN
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

Updated by the provider on Mar 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
300052762MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL email

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210715003101 IN Practitioner - Physician Assistant 5092117853 Reassigns benefits to 2 organizations

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
Orthopaedics-Indianapolis IncGroup PAC ID 7416860663, 357 clinicians
Fort Wayne Orthopaedics, LLCGroup PAC ID 7618965286, 65 clinicians

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 100Reported as group
Promoting interoperability
81
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10003233AINMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Wayne Orthopaedics, LLC CurrentSince Jul 13, 2021 Accepting new patients
Fort Wayne Orthopaedics LLC Physician Assistant CurrentSince Jul 13, 2021 Accepting new patients
Orthopaedics-Indianapolis, Inc CurrentSince Jul 19, 2025 Accepting new patients
Orthopaedics-Indianapolis, Inc CurrentSince Jul 19, 2025 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

  • Direct secure messaging: 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.

Hospital & facility affiliations 2

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": "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

Verify at the official NPI Registry.