Abraham Dagoberto Lopez Jr., PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2816 Issued in AZ

Practice address

5102 W Campbell Ave
Phoenix, AZ 85031-1703

Phone

(623) 848-5000

NPI assigned

Dec 15, 2005

Last updated

Dec 22, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 5

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

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cep America- Arizona, PC

  • Emergency Medicine Physician
  • Chandler, AZ
  • NPI 1780202804
  Medicare reassignment
• Emergency Group of Arizona Professional Corporation

  • Emergency Medicine Physician
  • Phoenix, AZ
  • NPI 1215275433
  Medicare reassignment
• Tec Emergency Physicians of Arizona, LLC

  • Emergency Care Clinic/Center
  • Gilbert, AZ
  • NPI 1245772870
  Medicare reassignment
• Cep America - Arizona PC

  • Emergency Medicine Physician
  • Mesa, AZ
  • NPI 1356021190
  NPD
• Cep America-Arizona, PC

  dba Vituity

  • Emergency Medicine Physician
  • Sun City, AZ
  • NPI 1306210224
  NPD
• Emergency Physician Professional Association, LTD.

  • Emergency Medicine Physician
  • Glendale, AZ
  • NPI 1396769972
  NPD (past)
• Emergency Physicians Professional Association LTD

  • Emergency Medicine Physician
  • Phoenix, AZ
  • NPI 1114931490
  NPD (past)
• Valley Emergency Physicians Inc

  • Emergency Medicine Physician
  • Phoenix, AZ
  • NPI 1043224322
  NPD (past)

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1073599619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4518 W PARADISE DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853043027",
            "telephone_number": "602-320-0580",
            "fax_number": "602-354-4171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5102 W CAMPBELL AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850311703",
            "telephone_number": "623-848-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "ABRAHAM",
        "middle_name": "DAGOBERTO",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2816",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "2816",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "817827",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET GROUP",
            "identifier": "AW1436",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYECARE",
            "identifier": "3987220",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH GROUP",
            "identifier": "453051001",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA-GROUP #",
            "identifier": "860373636",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Camila Lopez Perez
• Ricardo Lopez Soto, M.D.
• Lopez Wellness & Performance LLC
• Lopez Wellness & Performance LLC
• Adriana M Lopez-Piper
• Alejandro Lopez
• Alejandro Emilio Lopez, MD
• Alma L Lopez, LPN
• Andrew Lopez
• Andrew Lopez, ATS

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; 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.