Individual provider Active NPI

Mauricio Palacios Romero, NP

  • Family Nurse Practitioner
  • Yuma, AZ
National Provider Identifier
1114747524
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
239288 Issued in AZ
Practice address
1950 W 3Rd St
Yuma, AZ 85364-1812
Phone
(928) 276-4477
Fax
(928) 276-4481
NPI assigned
Oct 11, 2024
Last updated
Oct 14, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 239288 AZ Primary

Addresses

Primary practice location

1950 W 3Rd St
Yuma, AZ 85364-1812

Mailing address

4279 W 27TH PL
Yuma, AZ 85364-4696
Phone (928) 366-9225

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
I20241018003520 AZ Practitioner - Nurse Practitioner 7517499205 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Frances Davison FNP-BC LTDGroup PAC ID 4981018843, 7 clinicians
Indigo Healthcare LLCGroup PAC ID 6305260829, 5 clinicians

Practice addresses (Care Compare)

1950 W 3Rd St
Yuma, AZ 85364-1812
Phone (928) 276-4477

1990 McCulloch Blvd N
Suite 109
Lake Havasu City, AZ 86403-5749
Phone (888) 253-6598

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Indigo Healthcare LLC CurrentSince Oct 1, 2024 Accepting new patients
Frances Davison FNP-BC LTD CurrentSince Oct 11, 2024 Accepting new patients

Locations

1990 McCulloch Blvd N
Ste 109
Lake Havasu City, AZ 86403
Phone (928) 505-6473

11814 S Foothills Blvd
Ste 1
Yuma, AZ 85367
Phone (928) 248-4734

1950 W 3rd St
Yuma, AZ 85364
Phone (928) 276-4477

1916 N 700 W
Ste 110
Layton, UT 84041
Phone (801) 444-0221

Interoperability endpoints

  • Direct secure messaging: mauricio.palacios.1@8200.direct.athenahealth.com

Organizations & group practices 2

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 6

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": "1728604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1114747524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4279 W 27TH PL",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853644696",
            "telephone_number": "928-366-9225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 W 3RD ST",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853641812",
            "telephone_number": "928-276-4477",
            "fax_number": "928-276-4481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALACIOS ROMERO",
        "first_name": "MAURICIO",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-11",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "239288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yuma, AZ

Sources for this page

Verify at the official NPI Registry.