Active NPI
Nicolas Snyder, PAC
- Medical Physician Assistant
- Phoenix, AZ
National Provider Identifier
1154621381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 4749
- Practice address
- 2640 W Baseline Rd
Phoenix, AZ 85041-6492 - Phone
- (480) 677-8282
- Fax
- (480) 677-8283
- NPI assigned
- Oct 21, 2010
- Last updated
- Jul 23, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 4749 | AZ | Primary |
Addresses
Primary practice location
2640 W Baseline Rd
Phoenix, AZ 85041-6492
Mailing address
4600 S Mill Ave
Tempe, AZ 85282-6757
Phone (480) 305-2888
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 624191 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4749 | AZ | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Livn, P.C. | Past | Accepting new patients | |
| Welsh Company LLC | Past | Accepting new patients | |
| Ucxtra Umbrella, LLC | Past | Accepting new patients | |
| Next Level Facility LLC | Past | Accepting new patients |
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437609600000",
"number": "1154621381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4600 S MILL AVE",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852826757",
"telephone_number": "480-305-2888",
"fax_number": "480-305-2889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2640 W BASELINE RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850416492",
"telephone_number": "480-677-8282",
"fax_number": "480-677-8283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SNYDER",
"first_name": "NICOLAS",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-10-21",
"last_updated": "2015-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AZ",
"license": "4749",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "624191",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.