Individual provider Active NPI

Alisha Deponio, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Traverse City, MI
National Provider Identifier
1720749344
Registry record updated Jun 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
4704284761NSA2111S Issued in MI
Practice address
1200 Sixth St Ste 200
Traverse City, MI 49684-2369
Phone
(231) 935-5800
Fax
(231) 935-5799
NPI assigned
Jan 5, 2022
Last updated
Jun 8, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 4704284761NSA2111S MI Primary

Addresses

Primary practice location

1200 Sixth St Ste 200
Traverse City, MI 49684-2369

Mailing address

1200 Sixth St Ste 200
Traverse City, MI 49684-2369
Phone (231) 935-5800

Other practice location 1

1105 Sixth St
Traverse City, MI 49684-2345
Phone (231) 935-5000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address adeponio@mhc.net Direct

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
I20240214001575 MI Practitioner - Nurse Practitioner 0446694814 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Munson Medical GroupGroup PAC ID 8820277015, 191 clinicians

Practice addresses (Care Compare)

1200 6TH St
Suite 200
Traverse City, MI 49684-2369
Phone (231) 935-5800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704284761NSA2111SMIMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Group CurrentSince Dec 24, 2023 Accepting new patients
Munson Medical Group CurrentSince Dec 24, 2023 Accepting new patients
Munson Medical Center Past Accepting new patients

Locations

2891 Momentum Pl
Chicago, IL 60689

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

1200 Sixth St
Ste 200
Traverse City, MI 49684

Interoperability endpoints

  • Direct secure messaging: adeponio@direct.mhc.net

Organizations & group practices 3

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 1

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": "1641340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1720749344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 SIXTH ST STE 200",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842369",
            "telephone_number": "231-935-5800",
            "fax_number": "231-935-5799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SIXTH ST STE 200",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842369",
            "telephone_number": "231-935-5800",
            "fax_number": "231-935-5799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1105 Sixth St",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496842345",
            "country_code": "US",
            "telephone_number": "231-935-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEPONIO",
        "first_name": "ALISHA",
        "credential": "AGACNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-05",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704284761NSA2111S",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "adeponio@mhc.net",
            "affiliation": "N",
            "endpointDescription": "Munson work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1105 Sixth St",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496842345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.