NPIMap

Individual provider Active NPI

Kevin Lamar Redus, PA-C

  • Surgical Physician Assistant
  • Wickenburg, AZ
National Provider Identifier
1164425633
Registry record updated Apr 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
2477 Issued in AZ
Practice address
520 Rose LN
Wickenburg, AZ 85390-1447
Phone
(928) 684-5421
Fax
(289) 684-7457
NPI assigned
May 27, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2477 AZ
Surgical Physician Assistant 363AS0400X 2477 AZ Primary

Addresses

Primary practice location

520 Rose LN
Wickenburg, AZ 85390-1447

Mailing address

3811 E Bell Rd Ste 309
Phoenix, AZ 85032-2160
Phone (480) 420-0749

Other practice location 1

523 Rose Ln
Wickenburg, AZ 85390-1448
Phone (928) 668-1803

Other identifiers 3

IdentifierTypeStateIssuer
AZ0146700OtherAZBLUE CROSS BLUE SHIELD AZ
577786001MedicaidAZ
577786MedicaidAZ

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
I20040209000098 AZ Practitioner - Physician Assistant 8628961091 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Hospital Association IncGroup PAC ID 4981688900, 29 clinicians

Practice addresses (Care Compare)

519 Rose LN
Suite a
Wickenburg, AZ 85390-1448
Phone (928) 684-4365

523 Rose LN
Wickenburg, AZ 85390-1448

Hospital & facility affiliations

  • Wickenburg Community Hospital Hospital, Wickenburg, AZ, CCN 031300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2477AZMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Shea Urgent Care LLC Past Accepting new patients
Greenway Urgent Care LLC Past Accepting new patients
Dana Landing Urgent Care LLC Past Accepting new patients
Tucson Orthopaedic Institute Professional Corporation Physician Assistant Past Accepting new patients
Pinnacle Medicine Inc. Past Accepting new patients
Avondale Urgent Care LLC Past Accepting new patients
Chandler Urgent Care LLC Past Accepting new patients
VHS Outpatient Clinics, Inc. PastSince Aug 23, 2020 Accepting new patients
Desert Ridge Urgent Care LLC Past Accepting new patients
Sun City Urgent Care LLC Past Accepting new patients
Community Hospital Association, Inc. Past Accepting new patients
Glendale Urgent Care LLC Past Accepting new patients

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 1

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": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714089600000",
    "number": "1164425633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3811 E BELL RD STE 309",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322160",
            "telephone_number": "480-420-0749",
            "fax_number": "480-420-0732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 ROSE LN",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "853901447",
            "telephone_number": "928-684-5421",
            "fax_number": "289-684-7457"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "523 Rose Ln",
            "address_purpose": "LOCATION",
            "city": "Wickenburg",
            "state": "AZ",
            "postal_code": "853901448",
            "country_code": "US",
            "telephone_number": "928-668-1803",
            "fax_number": "928-684-2434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REDUS",
        "first_name": "KEVIN",
        "middle_name": "LAMAR",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "2477",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "2477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD AZ",
            "identifier": "AZ0146700",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "577786001",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "577786",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wickenburg, AZ

Sources for this page

Verify at the official NPI Registry.