Individual provider Active NPI

Chrismene Louis, PA

  • Medical Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1093570392
Registry record updated Feb 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1351 Issued in PR
Practice address
14020 N Black Canyon Hwy
Phoenix, AZ 85053-5800
Phone
(347) 278-0678
NPI assigned
Feb 15, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 24, 2024

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 9872 AZ
Medical Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363AM0700X 1351 PR Primary

Addresses

Primary practice location

14020 N Black Canyon Hwy
Phoenix, AZ 85053-5800

Mailing address

14020 N Black Canyon Hwy
Phoenix, AZ 85053-5800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

14020 N Black Canyon Hwy
Phoenix, AZ 85053

410 N Malacate St
Ajo, AZ 85321-2254

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9872AZMDDentist
1351PRMDMedical Physician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1707955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708732800000",
    "number": "1093570392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14020 N BLACK CANYON HWY",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850535800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14020 N BLACK CANYON HWY",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850535800",
            "telephone_number": "347-278-0678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOUIS",
        "first_name": "CHRISMENE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-15",
        "last_updated": "2024-02-24",
        "certification_date": "2024-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "9872",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "PR",
            "license": "1351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.