James Alton Callis Jr., PA-C
Individual provider Active NPI Physician Assistant · Littlefield, AZ
NPI 1003817610 · NPPES record last updated Sep 12, 2011
Key facts
- NPI
- 1003817610
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 4227 (AZ)
- Practice address
- 3272 E Rio Virgin Rd
Littlefield, AZ 86432-3200 - Phone
- (928) 347-5971
- Fax
- (928) 357-5793
- NPI assigned
- Aug 4, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140929000034 | GA | Practitioner - Physician Assistant | 7113964693 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 529 | ID | MD | Clinical Social Worker |
| PA529 | ID | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospital Authority of Jefferson County and the City of Louisville | Current |
Accepting new patients | |
| Hospital Authority of Jefferson County and the City of Louisville | Past | Accepting new patients | |
| Hospital Authority of Jefferson County and the City of Louisville | Past | Accepting new patients | |
| Richard Lochhead MD PLLC | Past |
Accepting new patients | |
| Valley Family Health Care, Inc | Past | Accepting new patients |
Locations
1067 Peachtree St
Louisville, GA 30434
Phone (478) 625-7000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | LL15374 | OR | |
| Physician Assistant | 363A00000X | PA529 | ID | |
| Physician Assistant | 363A00000X | 4227 | AZ | Yes |
Addresses
Primary practice location
3272 E Rio Virgin Rd
Littlefield, AZ 86432-3200
Mailing address
PO Box 1625
Page, AZ 86040-1625
Phone (928) 645-1700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 365217 | Medicaid | AZ |
Other names
- Jim Callis
Other providers in Littlefield, AZ
- Stephen M Adam
- Beaver Dam Littlefield Fire District
- Wendie G Black
- Alejandra Camacho
- Canyonlands Community Health Care
- Lacey Bennett Celani
- Community Bridges, Inc.
- Encompass Health Services
All providers in Littlefield, AZ · Physician Assistant in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.