Individual provider Active NPI

Melisa Ann Fazio, PA-C, ATC

  • Physician Assistant
  • Vail, CO
National Provider Identifier
1992830822
Registry record updated Feb 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0005261 Issued in CO
Practice address
181 W Meadow Dr Ste 400
Vail, CO 81657-5058
Phone
(970) 479-5880
NPI assigned
Feb 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X
Physician Assistant 363A00000X PA.0005261 CO Primary

Addresses

Primary practice location

181 W Meadow Dr Ste 400
Vail, CO 81657-5058

Mailing address

181 W Meadow Dr Ste 400
Vail, CO 81657-5058

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
I20200715002599 MI Practitioner - Physician Assistant 9335400951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Yale University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical Center MidlandGroup PAC ID 2264323633, 507 clinicians

Practice addresses (Care Compare)

4000 Wellness Dr
Midland, MI 48670-2000
Phone (989) 633-8018

4401 N Campus RDG Dr
Midland, MI 48640-6112
Phone (989) 837-9200

4500 Campus Ridge Dr
Midland, MI 48640-6123
Phone (989) 837-9250

Hospital & facility affiliations

  • Mymichigan Medical Center Midland Hospital, Midland, MI, CCN 230222
  • Mymichigan Medical Center Gladwin Hospital, Gladwin, MI, CCN 231325
  • Mymichigan Medical Center Clare Hospital, Clare, MI, CCN 230180

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0005261COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Midland CurrentSince Jul 13, 2020 Accepting new patients
Mymichigan Medical Center Midland CurrentSince Jul 13, 2020 Accepting new patients

Locations

4500 N Campus Ridge Dr
Midland, MI 48640
Phone (989) 837-9250

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

Interoperability endpoints

  • Direct secure messaging: mfazio96970@mymichiganhealth.midirect.net

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519171200000",
    "number": "1992830822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 W MEADOW DR STE 400",
            "city": "VAIL",
            "state": "CO",
            "postal_code": "816575058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 W MEADOW DR STE 400",
            "city": "VAIL",
            "state": "CO",
            "postal_code": "816575058",
            "telephone_number": "970-479-5880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZIO",
        "first_name": "MELISA",
        "middle_name": "ANN",
        "credential": "PA-C, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2018-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0005261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vail, CO

Sources for this page

Verify at the official NPI Registry.