Individual provider Active NPI

Analise Jacquelyn Betker, PA-C

  • Physician Assistant
  • Kalamazoo, MI
National Provider Identifier
1578931689
Registry record updated Aug 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601007476 Issued in MI
Practice address
6210 W. Main St
Kalamazoo, MI 49009
Phone
(269) 286-7030
Fax
(269) 286-7031
NPI assigned
Sep 4, 2015
Last updated
Aug 6, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2020

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 5601007476 MI Primary
Medical Physician Assistant 363AM0700X 5601007476 MI

Addresses

Primary practice location

6210 W. Main St
Kalamazoo, MI 49009

Mailing address

7901 Angling Rd
Portage, MI 49024-0714
Phone (269) 324-8600

Other practice location 1

7901 Angling Rd
Portage, MI 49024-0714
Phone (269) 324-8600

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
I20151008000220 MI Practitioner - Physician Assistant 9739497900 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bronson Methodist HospitalGroup PAC ID 0244148633, 721 clinicians

Practice addresses (Care Compare)

601 John St
Kalamazoo, MI 49007-5377

6210 W Main St
Kalamazoo, MI 49009-8925
Phone (269) 286-7030

6220 W Main St
Aec Clinic
Kalamazoo, MI 49009-8925
Phone (269) 276-4744

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601007476MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group Promed CurrentSince Sep 30, 2015 Accepting new patients
Bronson Methodist Hospital Physician Assistant CurrentSince Jul 1, 2020 Accepting new patients
Promed Healthcare CurrentSince Sep 30, 2015 Accepting new patients

Locations

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

408 Hazen St
Paw Paw, MI 49079
Phone (269) 341-8481

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1441324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596672000000",
    "number": "1578931689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7901 ANGLING RD",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240714",
            "telephone_number": "269-324-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6210 W. MAIN ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "49009",
            "telephone_number": "269-286-7030",
            "fax_number": "269-286-7031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7901 Angling Rd",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "MI",
            "postal_code": "490240714",
            "country_code": "US",
            "telephone_number": "269-324-8600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BETKER",
        "first_name": "ANALISE",
        "middle_name": "JACQUELYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-04",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007476",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601007476",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.