Elizabeth Ann Wennerstrom, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

7262 Issued in AZ

Practice address

13460 N 94TH Dr Ste J1
Peoria, AZ 85381-4264

Phone

(623) 876-8816

Fax

(623) 298-0168

NPI assigned

Dec 17, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Merit-based Incentive Payment System (MIPS)

Final score

99.15 of 100Reported as group

Promoting interoperability

99

Improvement activities

40

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 and National Provider Directory roles.

• Barnet Dulaney Perkins Eye Center, PC

  • Ophthalmology Physician
  • Phoenix, AZ
  • NPI 1376574707
  Medicare reassignment NPD
• Southwestern Eye Center LTD

  • Ophthalmology Physician
  • Scottsdale, AZ
  • NPI 1023063187
  Medicare reassignment NPD
• Joseph a Caplan MD PC

  • Cardiovascular Disease Physician
  • Peoria, AZ
  • NPI 1649389156
  Medicare reassignment
• Barnet Dulaney Perkins Eye Center, PC

  • Ambulatory Surgical Clinic/Center
  • Mesa, AZ
  • NPI 1043910078
  NPD
• Southwestern Eye Center, LTD

  • Durable Medical Equipment & Medical Supplies
  • Tempe, AZ
  • NPI 1558102608
  NPD

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

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1114498029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13460 N 94TH DR STE J1",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814264",
            "telephone_number": "623-876-8816",
            "fax_number": "623-298-0168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13460 N 94TH DR STE J1",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814264",
            "telephone_number": "623-876-8816",
            "fax_number": "623-298-0168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENNERSTROM",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-17",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "7262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125100",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark William Wellman, OD
• Wellness for Life Family Practice
• Wellness Today Medical Clinic, Inc.
• Janeen Lealice Wells, LPC
• Kiersten Wells, LCSW
• Amija Wento
• Katherine Sara Werner
• Todd Wertish
• West Point Optical Group
• West Valley Braces

• Medical Physician Assistant in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.
• 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.