Active NPI
Rebecca Lynn Childers, PA
- Physician Assistant
- Queen Creek, AZ
National Provider Identifier
1215068549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2760
- Practice address
- 22711 S Ellsworth Road
Suite 104
Queen Creek, AZ 85142 - Phone
- (480) 782-0993
- Fax
- (833) 337-0386
- NPI assigned
- Mar 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1293 | NE | |
| Physician Assistant | 363A00000X | 2760 | AZ | Primary |
Addresses
Primary practice location
22711 S Ellsworth Road
Suite 104
Queen Creek, AZ 85142
Mailing address
530 E Thomas Road
Phoenix, AZ 85012-3204
Phone (860) 678-3402
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100250445-00 | Medicaid | NE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1293 | NE | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nebraska Methodist Hospital | Physician Assistant | Past | Accepting new patients |
Organizations & group practices 1
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 Medicine Physician
- Omaha, NE
- NPI 1689628372
Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637280000000",
"number": "1215068549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "530 E THOMAS ROAD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850123204",
"telephone_number": "860-678-3402",
"fax_number": "844-364-3181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22711 S ELLSWORTH ROAD",
"address_2": "SUITE 104",
"city": "QUEEN CREEK",
"state": "AZ",
"postal_code": "85142",
"telephone_number": "480-782-0993",
"fax_number": "833-337-0386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHILDERS",
"first_name": "REBECCA",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-08",
"last_updated": "2021-11-19",
"certification_date": "2021-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NE",
"license": "1293",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "2760",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100250445-00",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Queen Creek, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.