NPIMap

Individual provider Active NPI

Stephanie Ewalt

  • Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1215455753
Registry record updated Mar 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
6862 Issued in AZ
Practice address
10240 W Indian School Rd Ste 115
Phoenix, AZ 85037-5905
Phone
(623) 243-9077
NPI assigned
Sep 5, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2025

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 6862 AZ Primary

Addresses

Primary practice location

10240 W Indian School Rd Ste 115
Phoenix, AZ 85037-5905

Mailing address

1312 W Bartlett Way
Chandler, AZ 85248-5506
Phone (520) 235-5377

Other practice location 1

3530 S Val Vista Dr # B109-110
Gilbert, AZ 85297-7318
Phone (480) 905-8485

Other practice location 2

1890 E Florence Blvd Ste 3
Casa Grande, AZ 85122-5642
Phone (480) 905-8485

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171101002996 AZ Practitioner - Physician Assistant 6901162205 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Center for Dermatology PLLCGroup PAC ID 1557355385, 69 clinicians

Practice addresses (Care Compare)

14275 N 87TH St
Suite 110
Scottsdale, AZ 85260-3696
Phone (480) 905-8485

1890 E Florence Blvd
Suite 3
Casa Grande, AZ 85122-5642
Phone (480) 905-8485

Merit-based Incentive Payment System (MIPS)

Final score
95.11 of 100Reported as group
Quality
100
Improvement activities
40
Cost
83.7

Merit-based Incentive Payment System (MIPS)

Final score
91.69 of 100Reported as group
Quality
91.59
Promoting interoperability
94
Improvement activities
40
Cost
76.9

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6862AZMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
English Dermatology PC Past Accepting new patients
Center for Dermatology, PLLC Past Accepting new patients
Regency Reconstruction PLLC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: stephanieewa@lalasercenter.emadirect.md
  • Direct secure messaging: stephanie.ewalt@pdpaz.emadirect.md

Organizations & group practices 6

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": "1504569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1215455753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 W BARTLETT WAY",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852485506",
            "telephone_number": "520-235-5377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10240 W INDIAN SCHOOL RD STE 115",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375905",
            "telephone_number": "623-243-9077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3530 S Val Vista Dr # B109-110",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852977318",
            "country_code": "US",
            "telephone_number": "480-905-8485",
            "fax_number": "480-905-7274",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1890 E Florence Blvd Ste 3",
            "address_purpose": "LOCATION",
            "city": "Casa Grande",
            "state": "AZ",
            "postal_code": "851225642",
            "country_code": "US",
            "telephone_number": "480-905-8485",
            "fax_number": "480-905-7274",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EWALT",
        "first_name": "STEPHANIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-05",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.