Active NPI
Lebron Dennis, PA-C
- Physician Assistant
- Phoenix, AZ
National Provider Identifier
1174142046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 8173
- Practice address
- 435 N 5TH St
Phoenix, AZ 85004-2157 - Phone
- (602) 827-2450
- NPI assigned
- Apr 10, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 8173 | AZ | Primary |
Addresses
Primary practice location
435 N 5TH St
Phoenix, AZ 85004-2157
Mailing address
1643 NW 136TH Ave Ste 100
Sunrise, FL 33323-2857
Phone (888) 447-2362
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8173 | AZ | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Az Skin Sub LLC | Single Specialty | Past | Accepting new patients |
| Exceptional Health Care Bullhead City LLC | Past | Accepting new patients | |
| Arizona Acute Medical Services 1 PC | Single Specialty | Past | Accepting new patients |
Organizations & group practices 7
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.
-
- Emergency Medical Services (Emergency Medicine) Physician
- Maricopa, AZ
- NPI 1447910229
-
- Emergency Medical Services (Emergency Medicine) Physician
- Bullhead City, AZ
- NPI 1518732023
-
- Emergency Medicine Physician
- Yuma, AZ
- NPI 1235857699
-
- Internal Medicine Physician
- Phoenix, AZ
- NPI 1104104488
-
- Hospitalist Physician
- Phoenix, AZ
- NPI 1154860674
Single Specialty
-
- Special Hospital
- Bullhead City, AZ
- NPI 1750092110
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629849600000",
"number": "1174142046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1643 NW 136TH AVE STE 100",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333232857",
"telephone_number": "888-447-2362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "435 N 5TH ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850042157",
"telephone_number": "602-827-2450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DENNIS",
"first_name": "LEBRON",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-10",
"last_updated": "2021-08-25",
"certification_date": "2020-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": "AZ",
"license": "8173",
"primary": true
}
],
"identifiers": [],
"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 Aug 25, 2021; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.