Nicole C Fallacaro, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4453 Issued in AZ

Practice address

2730 S Val Vista Dr
Gilbert, AZ 85295-1675

Phone

(480) 324-0300

NPI assigned

Mar 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2022 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Balance Hormone Center

  • Clinic/Center
  • Gilbert, AZ
  • NPI 1124495403
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325030400000",
    "number": "1174582290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7095 S FAWN AVE",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852989274",
            "telephone_number": "718-702-4796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 S VAL VISTA DR",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852951675",
            "telephone_number": "480-324-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALLACARO",
        "first_name": "NICOLE",
        "middle_name": "C",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-18",
        "last_updated": "2011-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "010718",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "4453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Faith Into Action, LLC
• Jihan Fajut
• Robert Wayne Fakler, PA
• Nicole Faldmo, PA-C
• Joel Alan Falk, M.D.
• Rachel Fallacaro
• Emileigh Linda Falterman, SLPA
• Family Doctors of Arizona, LLC
• Family Matters Counseling PLLC
• Family Tree Eye Care LLC

• Physician Assistant in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.