NPIMap

Individual provider Active NPI

Alexis M Izumi, P.A.

  • Medical Physician Assistant
  • Watervliet, MI
National Provider Identifier
1831401181
Registry record updated Nov 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5601007177 Issued in MI
Practice address
400 Medical Park Dr
Watervliet, MI 49098-9225
Phone
(694) 632-2422
NPI assigned
Jul 1, 2010
Last updated
Nov 8, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601007177 MI Primary

Addresses

Primary practice location

400 Medical Park Dr
Watervliet, MI 49098-9225

Mailing address

400 Medical Park Dr
Watervliet, MI 49098-9225
Phone (694) 632-2422

Other practice location 1

1234 Napier Ave
Saint Joseph, MI 49085-2112
Phone (269) 985-4632

Other names 1

  • Alexis Marin Former name

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
I20150109000940 MI Practitioner - Physician Assistant 1951551696 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1234 Napier Ave
Saint Joseph, MI 49085-2112

400 Medical Park Dr
Watervliet, MI 49098-9225
Phone (269) 463-3600

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Michigan, PLLC CurrentSince Jun 29, 2021 Accepting new patients
Pathology Assoc of Southwestern Michigan, PC Current Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince Oct 2, 2023 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Sep 14, 2022 Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince Oct 2, 2023 Accepting new patients
Sound Inpatient Physicians - Michigan, PLLC CurrentSince Jun 29, 2021 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Sep 14, 2022 Accepting new patients
Lakeland Community Hospital Watervliet Past Accepting new patients
Wellbridge of Clarkston, LLC Past Accepting new patients
Comprehensive Rehab Consultants PLLC Past Accepting new patients

Locations

6559 Paw Paw Ave
Coloma, MI 49038
Phone (269) 408-1660

7040 Red Arrow Hwy
Coloma, MI 49038
Phone (269) 468-4318

1 Atkinson Dr
Ludington, MI 49431
Phone (231) 843-2591

580 W College Ave
Marquette, MI 49855
Phone (906) 225-3131

31 N Saint Joseph Ave
Niles, MI 49120
Phone (269) 428-2417

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

3903 Hollywood Rd
Saint Joseph, MI 49085
Phone (269) 408-1100

400 Medical Park Dr
Watervliet, MI 49098
Phone (269) 463-3111

Interoperability endpoints

  • Direct secure messaging: aizumi1270068@epic00.corewelldirect.org

Organizations & group practices 13

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.

View all 13

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": "1277942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1831401181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MEDICAL PARK DR",
            "city": "WATERVLIET",
            "state": "MI",
            "postal_code": "490989225",
            "telephone_number": "694-632-2422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MEDICAL PARK DR",
            "city": "WATERVLIET",
            "state": "MI",
            "postal_code": "490989225",
            "telephone_number": "694-632-2422"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1234 Napier Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Joseph",
            "state": "MI",
            "postal_code": "490852112",
            "country_code": "US",
            "telephone_number": "269-985-4632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IZUMI",
        "first_name": "ALEXIS",
        "middle_name": "M",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-01",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601007177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEXIS",
            "last_name": "MARIN",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Watervliet, MI

Sources for this page

Verify at the official NPI Registry.