MICAH LYNN ANN CLUTTER (NPI# 1053948521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053948521 |
| Entity Type | Individual |
| Full Name | MICAH LYNN ANN CLUTTER |
| Practice Address |
324 Roxbury Rd Rockford IL 61107-5090 |
| Mailing Address |
Box 78534 Milwaukee WI 53278-8534 |
| Practice Telephone | 8153989491 |
| Practice Fax Number | 8153817498 |
| Mailing Telephone | 8153989491 |
| Mailing Fax Number | 8153817498 |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2020-07-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 363A00000X | Physician Assistant | 085-007766 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
324 ROXBURY RD |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61107-5090 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225036973 | Alicia A Heuser | Physician Assistant | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2005-07-07 |
| 1578180105 | Anna R Gibbons | Physical Therapist | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2020-06-30 |
| 1730705732 | Krista L Carlson | Physical Therapist | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2020-06-25 |
| 1821613274 | Erin B Thomas | Physical Therapist | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2020-06-11 |
| 1881232817 | Eleni Polites | Occupational Therapist | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2019-12-20 |
| 1316507890 | Ashley Ann Smith | Podiatrist | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2019-06-18 |
| 1093371197 | Christine M Piasecki | Physical Therapist | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2019-05-14 |
| 1831755024 | Suzanne Workman | Occupational Therapist | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2019-05-14 |
| 1861058950 | Paige A Lyford | Physical Therapist | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2019-05-14 |
| 1619449972 | Clayton Cooper Lewis | Physician Assistant | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2018-12-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356952139 | Jessica Marie Tamayo Fernandez | Pharmacist | 1145 Alpine Rd, Rockford, IL 61107 | 2020-08-13 |
| 1467092379 | Unknown Safa Fatima | Student in an Organized Health Care Education/Training Program | Mercyhealth Mulford Clinic, 5970 Churchview Drive, Rockford, IL 61107 | 2020-01-08 |
| 1194367912 | Matt J Kriebs | Nurse Practitioner | 1235 N Mulford Rd Suite 103, Rockford, IL 61107 | 2019-10-14 |
| 1265962336 | Mary Golembeck | Nurse Practitioner | 7290 Argus Dr, Rockford, IL 61107 | 2017-06-12 |
| 1831644749 | Tessa Lee | Occupational Therapist | 3422 Lauderdale Ln, Rockford, IL 61107 | 2016-08-20 |
| 1942626965 | Elevated Health Essentials, LLC | Chiropractor | 124 N Water St Ste 204e, Rockford, IL 61107 | 2014-03-14 |
| 1093139909 | Swedishamerican Hospital | Surgery | 1639 N Alpine Rd Ste 400, Rockford, IL 61107 | 2014-02-12 |
| 1346676582 | Christopher Anthony Ziganto | Pharmacist | 494 Bienterra Trail #2, Rockford, IL 61107 | 2013-09-19 |
| 1023358272 | Lavanya Durairajan | Physical Therapist | 7358 Shiligton Dr, Rockford, IL 61107 | 2013-02-26 |
| 1851523146 | Great Smiles of Rockford | Durable Medical Equipment & Medical Supplies | 780 N. Mulfrord Road, Rockford, IL 61107 | 2009-08-20 |
| Find all providers in zip 61107 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871063776 | Amira Al-basha | Physician Assistant | 1639 N Alpine Rd Ste 380, Rockford, IL 61107-1440 | 2018-12-04 |
| 1578042982 | Alyssa Margaret Vasylyuk | Physician Assistant | 2350 N Rockton Ave Fl 4, Rockford, IL 61103-3600 | 2018-08-08 |
| 1053778456 | Jamie Anticevich | Physician Assistant | 6595 East State Street, Rockford, IL 61108-2542 | 2016-01-15 |
| 1437534666 | Irene Dyer | Physician Assistant | 1560 Red Oak Ln, Rockford, IL 61107-2767 | 2015-07-29 |
| 1215250675 | Krista R Mohamed | Physician Assistant | 1401 E. State St., Swedish American Hospital, Rockford, IL 61104-2315 | 2010-03-12 |
| 1629121009 | Jason A. Kadar | Physician Assistant | 2902 Mcfarland Rd Ste 300, Rockford, IL 61107-6801 | 2007-01-19 |
| 1295805851 | Kristin Lynn King-shank | Physician Assistant | 171 Dogwood Dr Ne, Rockford, MI 49341-7361 | 2006-11-09 |
| 1245263268 | William John Stout | Physician Assistant | 1401 E State Street, Rockford, IL 61104 | 2006-07-10 |
| 1952356040 | Saint Anthony Medical Center | Physician Assistant | 6830 Villagreen Vw, Rockford, IL 61107-5639 | 2006-05-24 |
| 1972552131 | Andrea B Fulcomer | Physician Assistant | 2404 Charles St, Rockford, IL 61108-1602 | 2006-05-08 |
| Find all providers in ROCKFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.