Individual provider Active NPI

Diana Andreea Stan

  • Medical Physician Assistant
  • Glendale, AZ
National Provider Identifier
1114465598
Registry record updated Jul 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
6630 Issued in AZ
Practice address
18555 N 79TH Ave Ste B108
Glendale, AZ 85308
Phone
(623) 773-2848
NPI assigned
Feb 7, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 6630 AZ Primary

Addresses

Primary practice location

18555 N 79TH Ave Ste B108
Glendale, AZ 85308

Mailing address

1847 W Heatherbrae Dr
Phoenix, AZ 85015-4764

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
I20190305002991 AZ Practitioner - Physician Assistant 4981943149 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Unified Surgeons PLLCGroup PAC ID 4486098795, 5 clinicians

Practice addresses (Care Compare)

20333 N 19TH Ave
Suite 230
Phoenix, AZ 85027-9901
Phone (480) 707-9504

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6630AZMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Unified Surgeons PLLC Current Accepting new patients
Community Hospital Association, Inc. Past Accepting new patients
4C Medical Group PLC Past Accepting new patients

Locations

20333 N 19th Ave
Ste 230
Phoenix, AZ 85027
Phone (480) 707-9504

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1486425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531785600000",
    "number": "1114465598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1847 W HEATHERBRAE DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850154764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18555 N 79TH AVE STE B108",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "623-773-2848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAN",
        "first_name": "DIANA",
        "middle_name": "ANDREEA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-07",
        "last_updated": "2018-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "6630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.