Carissa L Ashtary Yazdi, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10002381A Issued in IN

Practice address

5050 N Clinton St
Fort Wayne, IN 46825

Phone

(260) 484-8551

Fax

(260) 482-5060

NPI assigned

May 31, 2016

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 identifiers 1

Other names 1

• Carissa L Libbenga Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

87.82 of 100Reported as group

Quality

85.67

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: clibbenga122563@direct.parkviewexchange.com

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541635200000",
    "number": "1609224732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5052 N CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468255822",
            "telephone_number": "260-484-8551",
            "fax_number": "260-482-5060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 N CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46825",
            "telephone_number": "260-484-8551",
            "fax_number": "260-482-5060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 Provident Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Warsaw",
            "state": "IN",
            "postal_code": "465803297",
            "country_code": "US",
            "telephone_number": "574-269-8301",
            "fax_number": "574-269-8302",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11136 Parkview Circle Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468451730",
            "country_code": "US",
            "telephone_number": "260-484-8551",
            "fax_number": "260-482-5060",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7920 W Jefferson Blvd",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468044168",
            "country_code": "US",
            "telephone_number": "260-484-8551",
            "fax_number": "260-482-5060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ASHTARY YAZDI",
        "first_name": "CARISSA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-31",
        "last_updated": "2018-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10002381A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300009169",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARISSA",
            "last_name": "LIBBENGA",
            "middle_name": "L",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Guy Chadwick Asher Jr., M.D.
• Tristan Ashford
• Amber Ashley
• William C. Ashman, MD
• Ashraf H. Hanna, M.D., P.C.
• Hannah Ashworth, MD
• Timothy James Ashworth, M.D.
• Solomon Asiedu, BS,PTA
• Sayeda Fatima Asim
• Mohamed Askar

• All providers in Fort Wayne, IN
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.

Verify at the official NPI Registry.