NPIMap

Individual provider Active NPI

Marisa Kehaunani Andrade, NP

  • Acute Care Nurse Practitioner
  • Gilbert, AZ
National Provider Identifier
1144743899
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP10415 Issued in AZ
Practice address
2946 E Banner Gateway Dr.
Gilbert, AZ 85234
Phone
(480) 256-6444
Fax
(480) 256-3682
NPI assigned
Jul 24, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X AP10415 AZ Primary

Addresses

Primary practice location

2946 E Banner Gateway Dr.
Gilbert, AZ 85234

Mailing address

2940 E Banner Gateway Dr. Suite #450
Gilbert, AZ 85234
Phone (480) 256-6444

Other practice location 1

6036 N 19th Ave Ste 502
Phoenix, AZ 85015-2143
Phone (480) 231-4922

Other practice location 2

6036 N 19th Ave Ste 502
Phoenix, AZ 85015-2143
Phone (480) 231-4922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170911002097 AZ Practitioner - Nurse Practitioner 2062785272 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pioneer Hospitalists, PLLCGroup PAC ID 0941290290, 50 clinicians

Practice addresses (Care Compare)

475 S Dobson Rd
Chandler, AZ 85224-5605
Phone (888) 488-7640

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP10415AZMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pioneer Hospitalists, PLLC CurrentSince Oct 16, 2022 Accepting new patients
Farid Ghebleh MD PC CurrentSince Aug 11, 2017 Accepting new patients
Agh Mesa LLC Past Accepting new patients
Suleiman Ali LLC PastSince Nov 29, 2020 Accepting new patients

Locations

1515 W Chandler Blvd
Chandler, AZ 85224
Phone (480) 389-9529

3100 W Ray Rd
Ste 201
Chandler, AZ 85226
Phone (269) 312-1446

3115 S Price Rd
Chandler, AZ 85248
Phone (480) 855-4011

9130 E Elliot Rd
Mesa, AZ 85212
Phone (480) 410-4500

2000 W Bethany Home Rd
Phoenix, AZ 85015
Phone (480) 209-4000

6036 N 19th Ave
Ste 502
Phoenix, AZ 85015
Phone (602) 529-5884

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1500854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1144743899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 E BANNER GATEWAY DR. SUITE #450",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85234",
            "telephone_number": "480-256-6444",
            "fax_number": "480-256-3682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2946 E BANNER GATEWAY DR.",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85234",
            "telephone_number": "480-256-6444",
            "fax_number": "480-256-3682"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6036 N 19th Ave Ste 502",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850152143",
            "country_code": "US",
            "telephone_number": "480-231-4922",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6036 N 19th Ave Ste 502",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850152143",
            "country_code": "US",
            "telephone_number": "480-231-4922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDRADE",
        "first_name": "MARISA",
        "middle_name": "KEHAUNANI",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-24",
        "last_updated": "2022-07-21",
        "certification_date": "2021-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "AP10415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

Verify at the official NPI Registry.