Individual provider Active NPI

Jacqueline Virginia Mooney

  • Physician Assistant
  • Globe, AZ
National Provider Identifier
1245998772
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9439 Issued in AZ
Practice address
5880 S Hospital Dr
Globe, AZ 85501-9447
Phone
(928) 425-3261
Fax
(928) 425-3859
NPI assigned
Dec 1, 2021
Last updated
Oct 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

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 9439 AZ Primary

Addresses

Primary practice location

5880 S Hospital Dr
Globe, AZ 85501-9447

Mailing address

5880 North Hospital Drive
Globe, AZ 85501
Phone (928) 425-3261

Other practice location 1

122 E 1700 S
Building 3
Provo, Utah 84606
Phone (801) 375-5125

Other practice location 2

9574 E 106th St
Fishers, IN 46037-9701
Phone (317) 999-3281

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
I20221117001096 AZ Practitioner - Physician Assistant 7113395419 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5880 S Hospital Dr
Globe, AZ 85501-9447
Phone (928) 425-3247

5990 S Hospital Dr
Globe, AZ 85501-9462
Phone (928) 425-8151

5994 S Hospital Dr
Globe, AZ 85501-9462
Phone (928) 425-7108

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9439AZMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cobre Valley Regional Medical Center CurrentSince Oct 23, 2022 Accepting new patients
Cobre Valley Regional Medical Center CurrentSince Oct 23, 2022 Accepting new patients
Cobre Valley Regional Medical Center CurrentSince Nov 12, 2025 Accepting new patients
Rocky Mountain University of Health Professions Foundation PastSince Feb 4, 2024 Accepting new patients
Cobre Valley Regional Medical Center Past Accepting new patients
Rocky Mountain University Health Center PastSince May 1, 2022 Accepting new patients

Locations

5880 S Hospital Dr
Globe, AZ 85501
Phone (928) 402-1217

5990 S Hospital Dr
Globe, AZ 85501
Phone (520) 402-9319

5994 S Hospital Dr
Globe, AZ 85501
Phone (928) 425-7108

1134 W US Highway 60
Superior, AZ 85173
Phone (520) 689-2423

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1245998772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5880 NORTH HOSPITAL DRIVE",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "85501",
            "telephone_number": "928-425-3261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5880 S HOSPITAL DR",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855019447",
            "telephone_number": "928-425-3261",
            "fax_number": "928-425-3859"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "122 E 1700 S",
            "address_2": "Building 3",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "Utah",
            "postal_code": "84606",
            "country_code": "US",
            "telephone_number": "801-375-5125",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9574 E 106th St",
            "address_purpose": "LOCATION",
            "city": "Fishers",
            "state": "IN",
            "postal_code": "460379701",
            "country_code": "US",
            "telephone_number": "317-999-3281",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOONEY",
        "first_name": "JACQUELINE",
        "middle_name": "VIRGINIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-01",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "9439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Globe, AZ

Sources for this page

Verify at the official NPI Registry.