Individual provider Active NPI

Jamie Lee Engstrom, PA-C

  • Physician Assistant
  • Litchfield Park, AZ
National Provider Identifier
1053538389
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2902 Issued in AZ
Practice address
14044 W Camelback Rd
Litchfield Park, AZ 85340-9428
Phone
(623) 935-9600
Fax
(623) 935-9602
NPI assigned
Apr 19, 2007
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2902 AZ Primary

Addresses

Primary practice location

14044 W Camelback Rd
Litchfield Park, AZ 85340-9428

Mailing address

14044 W Camelback Rd
Litchfield Park, AZ 85340-9428
Phone (623) 935-9600

Other practice location 1

4638 E Shea Blvd
Ste B 210
Phoenix, AZ 85028-3072
Phone (602) 867-7546

Other practice location 2

4638 E Shea Blvd
Ste B 210
Phoenix, AZ 85028-3072
Phone (602) 867-7546

Other practice location 3

21753 N 77th Ave
Peoria, AZ 85382-2110
Phone (623) 935-9600

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20050926000617 AZ Practitioner - Physician Assistant 9133153489 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pinnacle Family Medicine PLCGroup PAC ID 7012015670, 9 clinicians

Practice addresses (Care Compare)

14044 W Camelback Rd
Suite 204
Litchfield Park, AZ 85340-9426
Phone (623) 935-9600

21753 N 77TH Ave
Peoria, AZ 85382-2110
Phone (623) 935-9600

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Family Medicine PLC PastSince Sep 5, 2023 Accepting new patients
Saguaro Dermatology Associates LLC PastSince Jan 1, 2026 Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1053538389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14044 W CAMELBACK RD",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853409428",
            "telephone_number": "623-935-9600",
            "fax_number": "623-935-9602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14044 W CAMELBACK RD",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853409428",
            "telephone_number": "623-935-9600",
            "fax_number": "623-935-9602"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4638 E Shea Blvd",
            "address_2": "Ste B 210",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850283072",
            "country_code": "US",
            "telephone_number": "602-867-7546",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4638 E Shea Blvd",
            "address_2": "Ste B 210",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850283072",
            "country_code": "US",
            "telephone_number": "602-867-7546",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21753 N 77th Ave",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853822110",
            "country_code": "US",
            "telephone_number": "623-935-9600",
            "fax_number": "623-935-9602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENGSTROM",
        "first_name": "JAMIE",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-19",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Litchfield Park, AZ

Sources for this page

Verify at the official NPI Registry.