LYDIA FALES PA-C
NPI 1962116962
Physician Assistant in Grand Rapids, MI

NPI Status: Active since January 13, 2023

Contact Information

4100 EMBASSY DR SE STE 400
GRAND RAPIDS, MI
ZIP 49546
Phone: (616) 988-8220
Fax: (616) 957-3220

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Physician Visit Costs
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Physician Assistant
Accepts Insurance
PECOS Enrolled

About LYDIA FALES

This page provides the complete NPI Profile along with additional information for Lydia Fales, a primary care provider established in Grand Rapids, Michigan with a medical specialization in Physician Assistant. The healthcare provider is registered in the NPI registry with number 1962116962 assigned on January 2023. The practitioner's primary taxonomy code is 363A00000X with license number 5601011578 (MI). The provider is registered as an individual and her NPI record was last updated 3 years ago.

NPI: 1962116962
Provider Name: LYDIA FALES PA-C
Other Name: LYDIA DEN DULK
Other Name Type: Former Name (1)
Gender: Female
Entity Type: Individual
Location Address: 4100 EMBASSY DR SE STE 400 GRAND RAPIDS, MI 49546
Location Phone: (616) 988-8220
Location Fax: (616) 957-3220
Mailing Address: 4100 EMBASSY DR SE STE 400 GRAND RAPIDS, MI 49546
Mailing Phone: (616) 570-2820
Is Sole Proprietor?: Yes
Enumeration Date: 01-13-2023
Last Update Date: 01-24-2023
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A primary care provider (PCP) like Lydia Fales sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Physician Assistant
Taxonomy Code: 363A00000X
Type: Physician Assistants & Advanced Practice Nursing Providers
License No.: 5601011578
License State: MI
Taxonomy Description: 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.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Blue Cross Blue Shield of Michigan Mutual Insurance Company

Blue Cross� Premier PPO Bronze Extra - PPO
Blue Cross� Premier PPO Bronze HSA - PPO
Blue Cross� Premier PPO Bronze Secure - PPO
Blue Cross� Premier PPO Gold - PPO
Blue Cross� Premier PPO Gold Extra - PPO
Blue Cross� Premier PPO Silver - PPO
Blue Cross� Premier PPO Silver Extra - PPO
Blue Cross� Premier PPO Silver Saver HSA - PPO
Blue Cross� Premier PPO Value - PPO

Molina Healthcare

Gold 1 - HMO
Gold 1 with Adult Vision Services - HMO
Gold 8 - HMO
Silver 1 - HMO
Silver 1 with Adult Vision Services - HMO
Silver 12 with First 4 Primary Care Visits Free - HMO
Silver 8 - HMO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Lydia Fales is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes

Physician Visit Costs

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 49546 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

Average New Patient Price $84.74
Minimum New Patient Price $54.34
Maximum New Patient Price $166.68

Average New Patient Copayment $21.18
Minimum New Patient Copayment $13.58
Maximum New Patient Copayment $41.67

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

Average Established Patient Price $68.07
Minimum Established Patient Price $17.09
Maximum Established Patient Price $135.4

Average Established Patient Copayment $17.01
Minimum Established Patient Copayment $4.27
Maximum Established Patient Copayment $33.85

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	9	6	2	1	1	6	9	6	2
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	9	12	2	2	1	12	9	12
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 9 + 1 + 2 + 2 + 2 + 1 + 1 + 2 + 9 + 1 + 2 + 24 = 58
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 58 = 2									2

The NPI number 1962116962 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.