NPIMap

Individual provider Active NPI

Andrew John Tait, PA-C

  • Physician Assistant
  • Ironwood, MI
National Provider Identifier
1689677353
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601002513 Issued in MI
Practice address
N10565 Grandview LN
Ironwood, MI 49938-9622
Phone
(906) 932-1500
Fax
(906) 932-5630
NPI assigned
May 24, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601002513 MI Primary

Addresses

Primary practice location

N10565 Grandview LN
Ironwood, MI 49938-9622

Mailing address

N10565 Grandview LN
Ironwood, MI 49938-9622
Phone (906) 932-1500

Other identifiers 4

IdentifierTypeStateIssuer
12D87TAOtherMNBCBS
42985500MedicaidWI
5601002513OtherMIPHYSICIAN ASSISTANT LICEN
1034124OtherPREFERREDONE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080229000679 MI Practitioner - Physician Assistant 5698859536 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aspirus Ironwood Hospital and Clinics Inc 165 clinicians

Practice addresses (Care Compare)

N10561 Grandview LN
Ironwood, MI 49938-9622
Phone (906) 932-2525

N10561 Granview LN
Grand View Hospital
Ironwood, MI 49938-9622
Phone (906) 932-2525

N10565 Grand View Lane
Ironwood, MI 49938-9622

N10565 Grandview Lane
Ironwood, MI 49938-9622

N10565 Grandview LN Aspirus Ironwood
Aspirus Palliative Medicine Michi
Ironwood, MI 49938-9622
Phone (715) 843-1067

Hospital & facility affiliations

  • Aspirus at Home Home health agency, Hancock, MI, CCN 237212
  • Aspirus Ironwood Hospital Hospital, Ironwood, MI, CCN 231333

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601002513MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Ironwood Hospital & Clinics, Inc. CurrentSince Oct 1, 2006 Accepting new patients
Aspirus Ironwood Hospital & Clinics, Inc. CurrentSince Oct 1, 2006 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

N10561 Grandview Ln
Ironwood, MI 49938
Phone (906) 932-1500

N10565 Grandview Ln
Ironwood, MI 49938
Phone (906) 932-1500

Interoperability endpoints

  • Direct secure messaging: atait17792@direct.aspirus.org

Organizations & group practices 7

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 7

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": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689677353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N10565 GRANDVIEW LN",
            "city": "IRONWOOD",
            "state": "MI",
            "postal_code": "499389622",
            "telephone_number": "906-932-1500",
            "fax_number": "906-932-5630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N10565 GRANDVIEW LN",
            "city": "IRONWOOD",
            "state": "MI",
            "postal_code": "499389622",
            "telephone_number": "906-932-1500",
            "fax_number": "906-932-5630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAIT",
        "first_name": "ANDREW",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601002513",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "12D87TA",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42985500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT LICEN",
            "identifier": "5601002513",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERREDONE",
            "identifier": "1034124",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ironwood, MI

Sources for this page

Verify at the official NPI Registry.