Individual provider Active NPI

Loretta Katherine McPheeters, PA-C

  • Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1174698617
Registry record updated Aug 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2959 Issued in AZ
Practice address
4041 N Central Ave BLDG C
Phoenix, AZ 85012-3313
Phone
(602) 279-5262
Fax
(602) 279-5390
NPI assigned
Nov 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2959 AZ Primary

Addresses

Primary practice location

4041 N Central Ave BLDG C
Phoenix, AZ 85012-3313

Mailing address

4041 N Central Ave BLDG C
Phoenix, AZ 85012-3313
Phone (602) 279-5262

Other identifiers 1

IdentifierTypeStateIssuer
946056MedicaidAZ

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181022001651 AZ Practitioner - Physician Assistant 4880878404 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2959AZMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Native Health CurrentSince Aug 1, 2018 Accepting new patients
Native Health Past Accepting new patients

Locations

777 W Southern Ave
Ste 501
Mesa, AZ 85210
Phone (480) 550-4048

2423 W Dunlap Ave
Ste 140
Phoenix, AZ 85021
Phone (602) 246-0330

4041 N Central Ave
Bldg C
Phoenix, AZ 85012
Phone (602) 679-5262

Interoperability endpoints

  • Direct secure messaging: loretta.mcpheeters.p1@direct.nachci.nextgenshare.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409097600000",
    "number": "1174698617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4041 N CENTRAL AVE BLDG C",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850123313",
            "telephone_number": "602-279-5262",
            "fax_number": "602-279-5390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4041 N CENTRAL AVE BLDG C",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850123313",
            "telephone_number": "602-279-5262",
            "fax_number": "602-279-5390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCPHEETERS",
        "first_name": "LORETTA",
        "middle_name": "KATHERINE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2014-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "946056",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.