Individual provider Active NPI

Alexis Irene McClure, PA

  • Physician Assistant
  • Peru, IN
National Provider Identifier
1780490235
Registry record updated Oct 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10005026A Issued in IN
Practice address
750 N Broadway
Peru, IN 46970-1027
Phone
(260) 569-2120
NPI assigned
Dec 9, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 99999999999 IN
Physician Assistant 363A00000X 10005026A IN Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

750 N Broadway
Peru, IN 46970-1027

Mailing address

11109 Parkview Plaza Dr # 117
Fort Wayne, IN 46845-1701

Other practice location 1

1050 Wishard Blvd
Indianapolis, IN 46202-2872
Phone (317) 410-3911

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20251101000199 IN Practitioner - Physician Assistant 6406345024 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

11109 Parkview Plaza Dr
Suite 117
Fort Wayne, IN 46845-1701

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
99999999999INMDPediatrics Physician
10005026AINMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Parkview Wabash Hospital, Inc. Pediatrics CurrentSince Nov 30, 2025 Accepting new patients
Parkview Health System Inc Pediatrics CurrentSince Nov 30, 2025 Accepting new patients
Parkview Wabash Hospital, Inc. CurrentSince Nov 30, 2025 Accepting new patients
Parkview Wabash Hospital, Inc. Past Accepting new patients

Locations

817 Trail Ridge Rd
Albion, IN 46701
Phone (260) 373-9590

11109 Parkview Plaza Dr
#117
Fort Wayne, IN 46845
Phone (260) 266-6012

240 S Jefferson St
Ste B
Huntington, IN 46750
Phone (219) 259-0000

1104 N Wayne St
North Manchester, IN 46962
Phone (260) 982-2102

750 N Broadway
Peru, IN 46970
Phone (260) 569-2120

8 John Kissinger Dr
Wabash, IN 46992
Phone (260) 563-7421

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1733702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1780490235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 N BROADWAY",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469701027",
            "telephone_number": "260-569-2120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 Wishard Blvd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462022872",
            "country_code": "US",
            "telephone_number": "317-410-3911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCLURE",
        "first_name": "ALEXIS",
        "middle_name": "IRENE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-09",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "99999999999",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10005026A",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peru, IN

Sources for this page

Verify at the official NPI Registry.