Active NPI
Janie Park, RNFA
- Surgical Physician Assistant
- Mesa, AZ
National Provider Identifier
1003820010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- RN 032660
- Practice address
- 604 W Medina Ave
Mesa, AZ 85210-6848 - Phone
- (480) 545-2610
- Fax
- (480) 545-2673
- NPI assigned
- Jul 27, 2006
- 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | RN 032660 | AZ | Primary |
Addresses
Primary practice location
604 W Medina Ave
Mesa, AZ 85210-6848
Mailing address
604 W Medina Ave
Mesa, AZ 85210-6848
Phone (480) 545-2610
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1Z4903 | Other | AZ | HEALTHNET AZ |
| AZ0169450 | Other | AZ | BCBS AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN 032660 | AZ | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003820010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "604 W MEDINA AVE",
"city": "MESA",
"state": "AZ",
"postal_code": "852106848",
"telephone_number": "480-545-2610",
"fax_number": "480-545-2673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "604 W MEDINA AVE",
"city": "MESA",
"state": "AZ",
"postal_code": "852106848",
"telephone_number": "480-545-2610",
"fax_number": "480-545-2673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JANIE",
"credential": "RNFA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "AZ",
"license": "RN 032660",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET AZ",
"identifier": "1Z4903",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS AZ",
"identifier": "AZ0169450",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.