Individual provider Active NPI

Alexis V Taylor, PA

  • Physician Assistant
  • Johnston, IA
National Provider Identifier
1861788895
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
002237 Issued in IA
Practice address
5615 NW 86TH St
Johnston, IA 50131-1738
Phone
(515) 643-6000
Fax
(515) 643-6001
NPI assigned
Jun 28, 2011
Last updated
Feb 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

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 002237 IA Primary

Addresses

Primary practice location

5615 NW 86TH St
Johnston, IA 50131-1738

Mailing address

PO Box 1475
Des Moines, IA 50305-1475
Phone (515) 643-6000

Other names 1

  • Alexis Valeska Poduska Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20110915000385 IA Practitioner - Physician Assistant 6709057128 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinics IncGroup PAC ID 7911810882, 441 clinicians

Practice addresses (Care Compare)

5615 NW 86TH St
Johnston, IA 50131-1738

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinics, Inc CurrentSince Jan 29, 2024 Accepting new patients

Locations

405 SW 5th St
Ste E
Des Moines, IA 50309
Phone (515) 358-7259

5615 NW 86th St
Johnston, IA 50131
Phone (515) 223-5466

Organizations & group practices 2

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 4

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": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739404800000",
    "number": "1861788895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1475",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503051475",
            "telephone_number": "515-643-6000",
            "fax_number": "515-643-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5615 NW 86TH ST",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501311738",
            "telephone_number": "515-643-6000",
            "fax_number": "515-643-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "ALEXIS",
        "middle_name": "V",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-28",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "002237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEXIS",
            "last_name": "PODUSKA",
            "middle_name": "VALESKA",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Johnston, IA

Sources for this page

Verify at the official NPI Registry.