NPIMap

Individual provider Active NPI

Shawn Christopher Smith, PA-C

  • Surgical Physician Assistant
  • Mesa, AZ
National Provider Identifier
1023335627
Registry record updated Oct 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
4577 Issued in AZ
Practice address
1432 S. Dobson Road
Suite 501
Mesa, AZ 85202
Phone
(602) 404-3700
Fax
(602) 404-3703
NPI assigned
Apr 23, 2010
Last updated
Oct 2, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 4577 AZ Primary

Addresses

Primary practice location

1432 S. Dobson Road
Suite 501
Mesa, AZ 85202

Mailing address

1432 S. Dobson Road
Suite 501
Mesa, AZ 85202
Phone (602) 404-3700

Other identifiers 1

IdentifierTypeStateIssuer
Z138481OtherAZPTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100726000718 AZ Practitioner - Physician Assistant 1153454251 Reassigns benefits to 1 organization
I20170510002639 CO Practitioner - Physician Assistant 1153454251 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4121

2000 Boise Ave
Loveland, CO 80538-5006
Phone (970) 820-4640

2555 E 13TH St
Suite 105
Loveland, CO 80537-5134
Phone (970) 820-6300

4700 Lady Moon Dr
Fort Collins, CO 80528-4426

5890 W 13TH St
Greeley, CO 80634-4821

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4577AZMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Health Physicians Colorado LLC CurrentSince Oct 30, 2017 Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince Oct 30, 2017 Accepting new patients
Banner Physician Super Specialists Arizona LLC CurrentSince Dec 1, 2011 Accepting new patients
Banner Physician Super Specialists Arizona LLC CurrentSince Dec 1, 2011 Accepting new patients

Locations

1452 N Higley Rd
Gilbert, AZ 85234
Phone (480) 614-6655

5310 W Thunderbird Rd
Ste 301
Glendale, AZ 85306
Phone (480) 412-7474

5757 W Thunderbird Rd
Ste W406
Glendale, AZ 85306
Phone (480) 464-9400

1432 S Dobson Rd
Ste 301
Mesa, AZ 85202
Phone (480) 412-7120

1432 S Dobson Rd
Ste 501
Mesa, AZ 85202
Phone (480) 412-7474

9305 W Thomas Rd
Ste 380
Phoenix, AZ 85037
Phone (623) 327-4144

37000 N Gantzel Rd
San Tan Valley, AZ 85140
Phone (480) 394-4000

7575 E Earll Dr
Scottsdale, AZ 85251
Phone (480) 448-7500

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

Organizations & group practices 5

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

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1271980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349136000000",
    "number": "1023335627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1432 S. DOBSON ROAD",
            "address_2": "SUITE 501",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85202",
            "telephone_number": "602-404-3700",
            "fax_number": "602-404-3703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1432 S. DOBSON ROAD",
            "address_2": "SUITE 501",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85202",
            "telephone_number": "602-404-3700",
            "fax_number": "602-404-3703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SHAWN",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-23",
        "last_updated": "2012-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "4577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "Z138481",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.