Individual provider Active NPI

Nicole Otero, PA

  • Physician Assistant
  • Gilbert, AZ
National Provider Identifier
1104204320
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1900 N Higley Rd
Gilbert, AZ 85234-1604
Phone
(480) 543-2000
NPI assigned
May 7, 2015
Last updated
Sep 14, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary
Student in an Organized Health Care Education/Training Program 390200000X NU
Athletic Trainer 2255A2300X NU

Addresses

Primary practice location

1900 N Higley Rd
Gilbert, AZ 85234-1604

Mailing address

2520 S Plaza Dr Apt 1003
Tempe, AZ 85282-1028
Phone (847) 630-8630

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20211130002182 AZ Practitioner - Physician Assistant 0042600330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10401 W Thunderbird Blvd
Sun City, AZ 85351-3004
Phone (623) 832-4000

1400 S Dobson Rd
Banner Health Clinic
Mesa, AZ 85202-4707
Phone (480) 412-3000

1920 N Higley Rd
Suite 206
Gilbert, AZ 85234-1624
Phone (480) 543-6700

6644 E Baywood Ave
Banner Health Clinic
Mesa, AZ 85206-1747
Phone (480) 321-2000

9165 W Thunderbird Rd
Suite 200
Peoria, AZ 85381-4847
Phone (623) 285-1120

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.12 of 100Reported as group
Quality
76.35
Promoting interoperability
99
Improvement activities
40
Cost
71.55

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Physician Specialists Arizona LLC Current Accepting new patients
Banner Physician Specialists Arizona LLC CurrentSince Nov 2, 2021 Accepting new patients
Banner Physician Specialists Arizona LLC CurrentSince Nov 2, 2021 Accepting new patients

Locations

1125 S Alma School Rd
Ste 210
Chandler, AZ 85286
Phone (480) 256-4900

1900 N Higley Rd
Gilbert, AZ 85234
Phone (480) 543-2000

1920 N Higley Rd
Ste 206
Gilbert, AZ 85234
Phone (480) 543-6700

120 E Main St
Ste A
Payson, AZ 85541
Phone (928) 474-9744

9165 W Thunderbird Rd
Ste 200
Peoria, AZ 85381
Phone (623) 285-1120

37100 N Gantzel Rd
Ste 107
San Tan Vly, AZ 85140
Phone (480) 394-4480

10401 W Thunderbird Blvd
Sun City, AZ 85351
Phone (623) 815-7690

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1430956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1104204320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 S PLAZA DR APT 1003",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852821028",
            "telephone_number": "847-630-8630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 N HIGLEY RD",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852341604",
            "telephone_number": "480-543-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTERO",
        "first_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-07",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

Verify at the official NPI Registry.