Individual provider Active NPI

Jennifer Rae Quezada, NP

  • Acute Care Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1164809893
Registry record updated Mar 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP8094 Issued in AZ
Practice address
500 W Thomas Rd Ste 400
Phoenix, AZ 85013-4238
Phone
(602) 406-4786
Fax
(916) 636-4358
NPI assigned
May 1, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN161919 AZ
Acute Care Nurse Practitioner 363LA2100X AP8094 AZ Primary

Addresses

Primary practice location

500 W Thomas Rd Ste 400
Phoenix, AZ 85013-4238

Mailing address

PO Box 33269
Phoenix, AZ 85067-3269
Phone (602) 406-4786

Other identifiers 1

IdentifierTypeStateIssuer
053643MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150925001807 AZ Practitioner - Nurse Practitioner 8527376433 Reassigns benefits to 3 organizations
I20230824000117 TX Practitioner - Nurse Practitioner 8527376433 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sigma Surgical LLCGroup PAC ID 7416483300, 7 clinicians

Practice addresses (Care Compare)

5236 W University Ave
Suite 2900 BLDG 1
McKinney, TX 75071-8117
Phone (469) 617-6550

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Honorhealth Ambulatory CurrentSince Oct 22, 2021 Accepting new patients
Honorhealth CurrentSince Aug 8, 2019 Accepting new patients
Honorhealth CurrentSince Aug 8, 2019 Accepting new patients
Honorhealth Ambulatory CurrentSince Oct 22, 2021 Accepting new patients
Central Texas Surgical Associates CurrentSince May 9, 2023 Accepting new patients
Sigma Surgical LLC CurrentSince Dec 1, 2024 Accepting new patients
Honorhealth Ambulatory Current Accepting new patients
Acute Care Surgical Specialists, LLC CurrentSince Sep 8, 2015 Accepting new patients

Locations

250 E Dunlap Ave
Phoenix, AZ 85020
Phone (480) 331-6721

16601 N 40th St
Ste 227
Phoenix, AZ 85032
Phone (602) 633-3721

2500 W Utopia Rd
Ste 100
Phoenix, AZ 85027
Phone (623) 683-4462

16601 N 40th St
Ste 204
Phoenix, AZ 85032
Phone (602) 633-3721

19829 N 27th Ave
Phoenix, AZ 85027
Phone (602) 879-5720

10510 N 92nd St
Ste 200
Scottsdale, AZ 85258
Phone (480) 323-1250

7351 E Osborn Rd
Ste 200B
Scottsdale, AZ 85251
Phone (480) 882-5730

7400 E Osborn Rd
Scottsdale, AZ 85251
Phone (480) 481-4000

16772 W Bell Rd
Ste 110619
Surprise, AZ 85374
Phone (480) 466-0827

4370 Medical Arts Dr
Ste 200
Flower Mound, TX 75028
Phone (972) 219-6800

200 Medical Pkwy
Ste 360
Lakeway, TX 78738
Phone (512) 459-1131

5236 W University Dr
Ste 2900
McKinney, TX 75071
Phone (469) 617-6550

7200 Wyoming Springs Dr
Ste 500
Round Rock, TX 78681
Phone (512) 244-0111

Organizations & group practices 8

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.

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": "1430438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646870400000",
    "number": "1164809893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33269",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850673269",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W THOMAS RD STE 400",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134238",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEZADA",
        "first_name": "JENNIFER",
        "middle_name": "RAE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-01",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN161919",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "AP8094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053643",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.