NPIMap

Individual provider Active NPI

Ivory Morgan Marinakis, PA

  • Medical Physician Assistant
  • Prescott, AZ
National Provider Identifier
1225657190
Registry record updated Jan 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
8124 Issued in AZ
Practice address
1003 Willow Creek Rd
Prescott, AZ 86301-1641
Phone
(928) 771-5470
NPI assigned
Apr 10, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 8124 AZ Primary

Addresses

Primary practice location

1003 Willow Creek Rd
Prescott, AZ 86301-1641

Mailing address

PO Box 12033
Prescott, AZ 86304-2033

Other practice location 1

435 N 5th St
Phoenix, AZ 85004-2157
Phone (602) 827-2450

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address imarinak@yrmc.org Direct
Direct Messaging Address imarinak@yrmc.org Direct

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
I20200922001684 AZ Practitioner - Physician Assistant 1951729011 Reassigns benefits to 8 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Exceptional Health Care Prescott LLC PastSince Aug 1, 2024 Accepting new patients
Exceptional Health Care Bullhead City LLC PastSince Nov 19, 2023 Accepting new patients
Exceptional Health Care Maricopa LLC PastSince Jul 25, 2021 Accepting new patients

Organizations & group practices 11

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": "1586476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1225657190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12033",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863042033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 WILLOW CREEK RD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011641",
            "telephone_number": "928-771-5470"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "435 N 5th St",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850042157",
            "country_code": "US",
            "telephone_number": "602-827-2450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARINAKIS",
        "first_name": "IVORY",
        "middle_name": "MORGAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-10",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "8124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "imarinak@yrmc.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1003 Willow Creek Rd",
            "city": "Prescott",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "863011641",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "imarinak@yrmc.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1003 Willow Creek Rd",
            "city": "Prescott",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "863011641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.