Individual provider Active NPI

Jon Glenn Pace, M.D.

  • Anesthesiology Physician
  • Phoenix, AZ
National Provider Identifier
1245291244
Registry record updated Sep 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
35341 Issued in AZ
Practice address
1850 N Central Ave
Suite 1600
Phoenix, AZ 85004-4527
Phone
(602) 744-4765
Fax
(602) 744-4799
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A68757 CA
Anesthesiology Physician 207L00000X 35341 AZ Primary

Addresses

Primary practice location

1850 N Central Ave
Suite 1600
Phoenix, AZ 85004-4527

Mailing address

1850 N Central Ave
Suite 1600
Phoenix, AZ 85004-4527
Phone (602) 744-4765

Other identifiers 1

IdentifierTypeStateIssuer
107251MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, AZ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050602000304 CA Practitioner - AnesthesiologyPractitioner - Interventional Pain Management 6305889239 Reassigns benefits to 1 organization
I20061016000590 AZ Practitioner - Anesthesiology 6305889239 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35341AZMDAnesthesiology Physician
A68757CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
J Pace MD a Professional Corporation Anesthesiology CurrentSince Aug 19, 2019 Accepting new patients

Locations

8881 Fletcher Pkwy
Ste 100
La Mesa, CA 91942
Phone (619) 698-0930

3903 Waring Rd
Oceanside, CA 92056
Phone (760) 724-3293

15525 Pomerado Rd
Ste E2
Poway, CA 92064
Phone (858) 521-0030

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": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379548800000",
    "number": "1245291244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 N CENTRAL AVE",
            "address_2": "SUITE 1600",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850044527",
            "telephone_number": "602-744-4765",
            "fax_number": "602-744-4799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 N CENTRAL AVE",
            "address_2": "SUITE 1600",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850044527",
            "telephone_number": "602-744-4765",
            "fax_number": "602-744-4799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACE",
        "first_name": "JON",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2013-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A68757",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AZ",
            "license": "35341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107251",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.