Individual provider Active NPI

Rudy Noriega, PAC

  • Physician Assistant
  • Glendale, AZ
National Provider Identifier
1184647927
Registry record updated Nov 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2065 Issued in AZ
Practice address
5410 W Thunderbird Rd
Suite 101
Glendale, AZ 85306-4711
Phone
(602) 530-6189
NPI assigned
Jul 25, 2006
Last updated
Nov 24, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2010

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 2065 AZ Primary

Addresses

Primary practice location

5410 W Thunderbird Rd
Suite 101
Glendale, AZ 85306-4711

Mailing address

5822 W Hedgehog PL
Phoenix, AZ 85083-7395
Phone (602) 290-2103

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
I20061003000756 AZ Practitioner - Physician Assistant 4284639857 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Loop 101 Emergency Physicians LLC Physician Assistant CurrentSince Jul 1, 2006 Accepting new patients
Tri-City Express Care, PLLC CurrentSince Jun 16, 2012 Accepting new patients
Urgent Care Centers of Arizona, LLC Past Accepting new patients
Nextcare Arizona I JV LLC Past Accepting new patients
Ultimate Urgent Care Centers Past Accepting new patients
Arizona Heart Specialists PLLC Past Accepting new patients
Goodyear Urgent Care LLC Past Accepting new patients

Locations

495 N Pinal Pkwy
Ste 106
Florence, AZ 85132
Phone (520) 568-0573

890 W Elliot Rd
Ste 103
Gilbert, AZ 85233
Phone (480) 214-4466

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

7850 N Silverbell Rd
Ste 132
Tucson, AZ 85743
Phone (480) 500-2286

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290556800000",
    "number": "1184647927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5822 W HEDGEHOG PL",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850837395",
            "telephone_number": "602-290-2103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5410 W THUNDERBIRD RD",
            "address_2": "SUITE 101",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064711",
            "telephone_number": "602-530-6189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORIEGA",
        "first_name": "RUDY",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2010-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.