Logan Wade

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

5850 E Still Cir
Mesa, AZ 85206-3618

Phone

(602) 301-7745

NPI assigned

Jun 9, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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 Physician Super Specialists Arizona LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1841573870
  Medicare reassignment NPD (past)
• Banner Physician Super Specialists Arizona LLC

  • Durable Medical Equipment & Medical Supplies
  • Mesa, AZ
  • NPI 1386462810
  NPD

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

{
    "created_epoch": "1686268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1063196186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5850 E STILL CIR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5850 E STILL CIR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063618",
            "telephone_number": "602-301-7745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "LOGAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-09",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylee Wada, DNP, FNP-C
• Amanda Waddell, D.O.
• Stephanie Waddell
• Rachel Claire Waddill, DDS
• E. Mark Wade, DDS
• Richard Earl Wade, FNP-BC
• Rick C Wade, ATC
• Harpreet Singh Wadhwa, MD
• Scott S Wagers
• Aniruddha Wagh, DDS

• Physician Assistant in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.