Alysa Michelle Clark, MD - Medicare Emergency Medicine in Grand Rapids, MI

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Alysa Michelle Clark, MD is a medicare enrolled "Emergency Medicine - Pediatric Emergency Medicine" physician in Grand Rapids, Michigan. Her current practice location is 100 Michigan St Ne # Mc049, Grand Rapids, Michigan. You can reach out to her office (for appointments etc.) via phone at (616) 391-1680.

Alysa Michelle Clark is licensed to practice in Michigan (license number 4301504949) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1356903371.

Contact Information

Alysa Michelle Clark, MD
100 Michigan St Ne # Mc049,
Grand Rapids, MI 49503-2560
(616) 391-1680
Not Available

Map and Direction




Physician's Profile

Full NameAlysa Michelle Clark
GenderFemale
SpecialityEmergency Medicine - Pediatric Emergency Medicine
Location100 Michigan St Ne # Mc049, Grand Rapids, Michigan
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1356903371
  • Provider Enumeration Date: 06/29/2019
  • Last Update Date: 04/09/2024
  Medicare PECOS Information:
  • PECOS PAC ID: 7719216068
  • Enrollment ID: I20211215002907

Medical Identifiers

Medical identifiers for Alysa Michelle Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1356903371NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207P00000XEmergency Medicine 4351045601 (Michigan)Secondary
207PP0204XEmergency Medicine - Pediatric Emergency Medicine 4301504949 (Michigan)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Alysa Michelle Clark allows following entities to bill medicare on her behalf.
Entity NameSpectrum Health Primary Care Partners
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1235188673
PECOS PAC ID: 4587568647
Enrollment ID: O20031121000091
Entity NameVisionary Medical Services, Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1538216569
PECOS PAC ID: 1951404185
Enrollment ID: O20070308000475
Entity NameEcs Western Michigan Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1992281000
PECOS PAC ID: 8628327384
Enrollment ID: O20180814003001

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Alysa Michelle Clark is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Alysa Michelle Clark, MD
4100 Embassy Dr Se Ste 400,
Grand Rapids, MI 49546-2416

Ph: (616) 975-1845		Alysa Michelle Clark, MD
100 Michigan St Ne # Mc049,
Grand Rapids, MI 49503-2560

Ph: (616) 391-1680

Reviews and Comments


Emergency Medicine Doctors in Grand Rapids, MI

Dr. Adam Michael Anderson, MD
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Mark G Kanitz, MD
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Colleen M Bush, MD
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Practice Location: 100 Michigan St Ne, Grand Rapids, MI 49503
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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.