Kevin Earlywine, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2140 Issued in AZ

Practice address

40773 N Ironwood Dr
San Tan Valley, AZ 85140-7002

Phone

(602) 714-1271

Fax

(480) 987-6566

NPI assigned

Feb 22, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Banner Urgent Care Services LLCGroup PAC ID 4284921610, 207 clinicians

Banner Urgent Care Arizona LLCGroup PAC ID 3678749496, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations (25 of 44)

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Banner Urgent Care Arizona LLC

  • Urgent Care Clinic/Center
  • Casa Grande, AZ
  • NPI 1316349855
  Medicare reassignment Care Compare group
• Banner Urgent Care Services, LLC

  • Urgent Care Clinic/Center
  • Scottsdale, AZ
  • NPI 1609229764
  Medicare reassignment Care Compare group
• Banner Urgent Care Arizona LLC

  • Urgent Care Clinic/Center
  • Payson, AZ
  • NPI 1194369074
  NPD
• Banner Urgent Care Services, LLC

  • Urgent Care Clinic/Center
  • San Tan Valley, AZ
  • NPI 1942653019
  NPD
• Banner Urgent Care Services, LLC

  • Urgent Care Clinic/Center
  • Tucson, AZ
  • NPI 1962855031
  NPD
• East Valley Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Phoenix, AZ
  • NPI 1619228335
  NPD (past)
• East Valley Urgent Care, LLC

  • Urgent Care Clinic/Center
  • San Tan Valley, AZ
  • NPI 1649515347
  NPD (past)
• East Valley Urgent Care,LLC

  • Urgent Care Clinic/Center
  • Phoenix, AZ
  • NPI 1235481128
  NPD (past)
• East Valley Urgent Care,LLC

  • Urgent Care Clinic/Center
  • Tempe, AZ
  • NPI 1710222419
  NPD (past)
• Heart Health Care LLC

  • Adult Health Nurse Practitioner
  • Show Low, AZ
  • NPI 1508987827
  NPD (past)
• Integrated Premier Group Ipg

  • Hospitalist Physician
  • Phoenix, AZ
  • NPI 1497176788
  NPD (past)
• Tri-City Cardiology Consultants, PC

  • Cardiovascular Disease Physician
  • Mesa, AZ
  • NPI 1144288416
  NPD (past)

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429660800000",
    "number": "1023083144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 S CLEARVIEW AVE STE 100",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852093378",
            "telephone_number": "480-988-9108",
            "fax_number": "480-813-4460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40773 N IRONWOOD DR",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851407002",
            "telephone_number": "602-714-1271",
            "fax_number": "480-987-6566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EARLYWINE",
        "first_name": "KEVIN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2015-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z173812",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501347",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in San Tan Valley, AZ
• Providers in San Tan Valley, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.