Elizabeth Ann Otter, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601004658 Issued in MI

Practice address

3290 N Wellness Dr Ste 240
Holland, MI 49424-7261

Phone

(616) 395-9379

Fax

(616) 820-1457

NPI assigned

Jul 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Elizabeth Ann Milroy Former name

Medicare fee-for-service enrollment

Enrolled in MI, TN2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jack a Dekkinga MD PCGroup PAC ID 3375538432, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
• Holland Hospital Hospital, Holland, MI, CCN 230072

Merit-based Incentive Payment System (MIPS)

Final score

99.15 of 100Reported as group

Promoting interoperability

99

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Jack a Dekkinga MD PC

  • Dermatology Physician
  • Grandville, MI
  • NPI 1609896034
  Medicare reassignment Care Compare group
• Stones River Dermatology PLC

  • Dermatology Physician
  • Murfreesboro, TN
  • NPI 1609178102
  Medicare reassignment
• Advanced Diagnostic Imaging, PC

  • Internal Medicine Physician
  • Goodlettsville, TN
  • NPI 1093741464

  Physician Assistant

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Holland Community Hospital

  • General Acute Care Hospital
  • Holland, MI
  • NPI 1871672618
  Care Compare affiliation
• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Spectrum Health Hospitals

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1639108293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 RIVERTOWN POINT CT SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494183076",
            "telephone_number": "616-257-3344",
            "fax_number": "616-457-1491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3290 N WELLNESS DR STE 240",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494247261",
            "telephone_number": "616-395-9379",
            "fax_number": "616-820-1457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTER",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "PA0000001490",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "MILROY",
            "middle_name": "ANN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ottawa County CMH
• Ottawa County Community Mental Health
• Ottawa County Community Mental Health Authority
• Ottawa County Community Mental Health Authority
• Ottawa Village Chiropractic, PLC
• Rebekah Oum
• Aaron Overhiser, DPT
• Emma Overkamp
• Kaylee J Owczarski
• Martha J Owocki, RDH

• Physician Assistant in Holland, MI
• Providers in Holland, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.

Verify at the official NPI Registry.