NPIMap

Individual provider Active NPI

Yvette Thorson, PA

  • Medical Physician Assistant
  • Goodyear, AZ
National Provider Identifier
1053576991
Registry record updated Feb 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1328 Issued in AZ
Practice address
750 N Estrella Pkwy Ste 60
Goodyear, AZ 85338-9279
Phone
(623) 321-5079
Fax
(623) 321-5083
NPI assigned
Jul 21, 2008
Last updated
Feb 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2021

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 1328 AZ Primary
Nurse Practitioner 363L00000X 1328 AZ

Addresses

Primary practice location

750 N Estrella Pkwy Ste 60
Goodyear, AZ 85338-9279

Mailing address

750 N Estrella Pkwy Ste 60
Goodyear, AZ 85338-9279
Phone (623) 321-5079

Other identifiers 1

IdentifierTypeStateIssuer
933194MedicaidAZ

Other names 1

  • Yvette Moore Former name

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)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1328AZMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Oncology & Hematology, PC Past Accepting new patients
Ponderosa Family Care, LLC Past Accepting new patients
Laser Spine Institute of Arizona, LLC Past Accepting new patients
Laser Spine Institute, LLC Past Accepting new patients
Honorhealth Medical Group, LLC Past Accepting new patients
Privia Medical Group Arizona, LLC Past Accepting new patients
Privia Medical Group Arizona, LLC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CEIBDA

Organizations & group practices 7

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": "1216598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612828800000",
    "number": "1053576991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 N ESTRELLA PKWY STE 60",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853389279",
            "telephone_number": "623-321-5079",
            "fax_number": "623-321-5083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 N ESTRELLA PKWY STE 60",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853389279",
            "telephone_number": "623-321-5079",
            "fax_number": "623-321-5083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THORSON",
        "first_name": "YVETTE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-21",
        "last_updated": "2021-02-09",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "1328",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "1328",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "933194",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "YVETTE",
            "last_name": "MOORE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.