Individual provider Active NPI

Jeannine L. Paquette, P.A.

  • Surgical Physician Assistant
  • Cottonwood, AZ
National Provider Identifier
1255458469
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
7412 Issued in AZ
Practice address
269 S Candy LN
Cottonwood, AZ 86326-4158
Phone
(928) 634-1331
Fax
(928) 634-3130
NPI assigned
Mar 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 001475 CT
Surgical Physician Assistant 363AS0400X 7412 AZ Primary

Addresses

Primary practice location

269 S Candy LN
Cottonwood, AZ 86326-4158

Mailing address

1200 N Beaver St
Flagstaff, AZ 86001-3118
Phone (928) 213-6235

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
I20200820000856 AZ Practitioner - Physician Assistant 0547225708 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Arizona Healthcare CorporationGroup PAC ID 3577473362, 391 clinicians

Practice addresses (Care Compare)

1200 N Beaver St
Flagstaff, AZ 86001-3118
Phone (928) 779-3366

2000 S Thompson St
Flagstaff, AZ 86001-8759
Phone (928) 226-6400

269 S Candy LN
Cottonwood, AZ 86326-4158
Phone (928) 639-6000

Hospital & facility affiliations

  • Verde Valley Medical Center Hospital, Cottonwood, AZ, CCN 030007

Merit-based Incentive Payment System (MIPS)

Final score
82.13 of 100Reported as group
Quality
66.85
Promoting interoperability
99
Improvement activities
40
Cost
74.4

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001475CTMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Arizona Healthcare Corporation CurrentSince Aug 15, 2020 Accepting new patients
Northern Arizona Healthcare Corporation CurrentSince Aug 15, 2020 Accepting new patients
Flagstaff Pathology Associates Current Accepting new patients

Locations

269 S Candy Ln
Cottonwood, AZ 86326
Phone (928) 634-2251

1200 N Beaver St
Flagstaff, AZ 86001
Phone (928) 213-6235

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1255458469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N BEAVER ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013118",
            "telephone_number": "928-213-6235",
            "fax_number": "928-213-6292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 S CANDY LN",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264158",
            "telephone_number": "928-634-1331",
            "fax_number": "928-634-3130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAQUETTE",
        "first_name": "JEANNINE",
        "middle_name": "L.",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "001475",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "7412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cottonwood, AZ

Sources for this page

Verify at the official NPI Registry.