Individual provider Active NPI

Jesus Fernando Hernandez, MD

  • Specialist
  • Casa Grande, AZ
National Provider Identifier
1073591475
Registry record updated Nov 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
29091 Issued in AZ
Practice address
803 N Salk Dr
Casa Grande, AZ 85222-5447
Phone
(520) 836-6682
Fax
(520) 836-6703
NPI assigned
Jan 5, 2006
Last updated
Nov 1, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 29091 AZ Primary

Addresses

Primary practice location

803 N Salk Dr
Casa Grande, AZ 85222-5447

Mailing address

PO Box 61773
Phoenix, AZ 85082-1773
Phone (602) 682-6701

Other identifiers 2

IdentifierTypeStateIssuer
WCSKQOtherAZSUN HEALTH GRP#
632390MedicaidAZ

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
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Pima Heart Physicians, PC Past Accepting new patients
Premier Cardiovascular Center, PLC Past Accepting new patients
Premier Cardiovascular Center, PLC Past Accepting new patients
Pima Heart Physicians, PC Past Accepting new patients
Pima Heart Physicians, PC Past Accepting new patients

Interoperability endpoints

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193875200000",
    "number": "1073591475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 61773",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850821773",
            "telephone_number": "602-682-6701",
            "fax_number": "602-240-6177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 N SALK DR",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "852225447",
            "telephone_number": "520-836-6682",
            "fax_number": "520-836-6703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "JESUS",
        "middle_name": "FERNANDO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2007-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "29091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUN HEALTH GRP#",
            "identifier": "WCSKQ",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "632390",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Casa Grande, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; 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.