Katelyn Anne Virnelson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

36457 N Gantzel Rd Ste 101
San Tan Valley, AZ 85140-7343

Phone

(480) 214-9000

NPI assigned

Dec 29, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Katelyn Nicolas Former name

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Enticare PCGroup PAC ID 2264532779, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CFAHBA/Endpoint/CFAHBA

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.

• Enticare PC

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Chandler, AZ
  • NPI 1710014410
  Medicare reassignment Care Compare group
• Enticare PC

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • San Tan Valley, AZ
  • NPI 1598520074
  NPD
• Sjhmc Physician Services

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1326098005
  NPD (past)

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

{
    "created_epoch": "1514505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672963200000",
    "number": "1144737172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2051 W CHANDLER BLVD STE 5",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852246239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36457 N GANTZEL RD STE 101",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851407343",
            "telephone_number": "480-214-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIRNELSON",
        "first_name": "KATELYN",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-29",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATELYN",
            "last_name": "NICOLAS",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Oladiji Gbolahan Vaughan, MD
• James Verdieu
• Victory Health Home PLLC
• Victory Residential Corporation
• Hunter Vincent, PT
• Ashley Vliet, RBT
• Iryna Von Esch, LCSW
• Walgreen Co
• Walgreen Co
• Walmart Inc.

• Physician Assistant in San Tan Valley, AZ
• Providers in San Tan Valley, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; 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.