Individual provider Active NPI

Michelle Lee Roy, PA

  • Pain Medicine Physician
  • Mesa, AZ
National Provider Identifier
1013091933
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
2364 Issued in AZ
Practice address
6840 E Brown Rd
Ste 101
Mesa, AZ 85207-3759
Phone
(480) 285-2150
Fax
(480) 285-2151
NPI assigned
Oct 25, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2364 AZ
Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0000X 2364 AZ Primary

Addresses

Primary practice location

6840 E Brown Rd
Ste 101
Mesa, AZ 85207-3759

Mailing address

6840 E Brown Rd
Ste 101
Mesa, AZ 85207-3759
Phone (480) 285-2150

Other practice location 1

9700 N 91st St Ste A115
Scottsdale, AZ 85258-5036
Phone (888) 803-3370

Other identifiers 2

IdentifierTypeStateIssuer
1029902OtherAZPA CERTIFICATION
2364OtherAZAZ PHYSICIAN ASST LICENS

Other names 1

  • Miss Michelle Lee Laliberte Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Oct 1, 2020 through Oct 1, 2026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2364AZMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Architetrics PC Single Specialty PastSince Apr 1, 2003 Accepting new patients
Puerto Sonora Internal Medicine Single Specialty PastSince Mar 1, 2021 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1013091933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6840 E BROWN RD",
            "address_2": "STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852073759",
            "telephone_number": "480-285-2150",
            "fax_number": "480-285-2151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6840 E BROWN RD",
            "address_2": "STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852073759",
            "telephone_number": "480-285-2150",
            "fax_number": "480-285-2151"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9700 N 91st St Ste A115",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852585036",
            "country_code": "US",
            "telephone_number": "888-803-3370",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROY",
        "first_name": "MICHELLE",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "2364",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "AZ",
            "license": "2364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA CERTIFICATION",
            "identifier": "1029902",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ PHYSICIAN ASST  LICENS",
            "identifier": "2364",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "LALIBERTE",
            "middle_name": "LEE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.