Active NPI
Jennifer Song
- Student in an Organized Health Care Education/Training Program
- Phoenix, AZ
National Provider Identifier
1003519216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 26224 N Tatum Blvd Ste 5
Phoenix, AZ 85050-7500 - Phone
- (480) 882-7580
- Fax
- (480) 563-7442
- NPI assigned
- Mar 24, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
26224 N Tatum Blvd Ste 5
Phoenix, AZ 85050-7500
Mailing address
7400 E Thompson Peak Pkwy
Scottsdale, AZ 85255-4109
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240729003483 | AZ | Order and Referring Only - Internal Medicine | 8628514403 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712016000000",
"number": "1003519216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7400 E THOMPSON PEAK PKWY",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "852554109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26224 N TATUM BLVD STE 5",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850507500",
"telephone_number": "480-882-7580",
"fax_number": "480-563-7442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "JENNIFER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-24",
"last_updated": "2024-04-02",
"certification_date": "2024-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.