Individual provider Active NPI

Alyssa Lazarski, PA-C

  • Physician Assistant
  • Green Bay, WI
National Provider Identifier
1912718388
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2360 Duck Creek Pkwy
Green Bay, WI 54303-3300
Phone
(920) 965-0345
NPI assigned
Jan 15, 2025
Last updated
Jan 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 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 Primary

Addresses

Primary practice location

2360 Duck Creek Pkwy
Green Bay, WI 54303-3300

Mailing address

2360 Duck Creek Pkwy
Green Bay, WI 54303-3300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20250227003856 WI Practitioner - Physician Assistant 6002336435 Reassigns benefits to 1 organization
I20250326003659 MI Practitioner - Physician Assistant 6002336435 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Rush Medical College of Rush University, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Dermatology Group LTDGroup PAC ID 9537312665, 23 clinicians

Practice addresses (Care Compare)

100 County Rd B
Shawano, WI 54166-7072
Phone (920) 965-0345

1606 S Stephenson Ave
Iron Mountain, MI 49801-3636
Phone (920) 965-0345

2360 Duck Creek Pkwy
Green Bay, WI 54303-3300
Phone (920) 965-0345

2500 E Capital Dr
Appleton, WI 54911-8735
Phone (920) 569-6549

2601 1St Ave N
Escanaba, MI 49829-1448
Phone (920) 965-0345

3059 Voyager Dr
Green Bay, WI 54311-8303
Phone (920) 965-0345

710 Riverside Dr
Waupaca, WI 54981-1941
Phone (920) 965-0345

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
New Dermatology Group LTD PastSince Jan 19, 2025 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: alyssa.lazarski.1@23194.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1736899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1912718388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2360 DUCK CREEK PKWY",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2360 DUCK CREEK PKWY",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033300",
            "telephone_number": "920-965-0345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAZARSKI",
        "first_name": "ALYSSA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-15",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.