Individual provider Active NPI

Jacqueline Sutter-Padilla, PA-S

  • Medical Physician Assistant
  • Mesa, AZ
National Provider Identifier
1275297178
Registry record updated Oct 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
5850 E Still Cir
Mesa, AZ 85206-3618
Phone
(480) 219-6000
NPI assigned
Oct 26, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 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 Primary

Addresses

Primary practice location

5850 E Still Cir
Mesa, AZ 85206-3618

Mailing address

13259 Lois Brooks St
Unit D
El Paso, TX 79908
Phone (954) 732-6926

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20230328003004 FL Practitioner - Physician Assistant 6709250087 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
FL-I Medical Services LLC CurrentSince Jan 1, 2023 Accepting new patients
FL-I Medical Services LLC CurrentSince Jan 1, 2023 Accepting new patients

Locations

322 SW Pine Island Rd
Cape Coral, FL 33991
Phone (941) 249-6858

996 Airport Rd
Destin, FL 32541
Phone (615) 338-1250

20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290

Organizations & group practices 4

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": "1635206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1275297178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13259 LOIS BROOKS ST",
            "address_2": "UNIT D",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79908",
            "telephone_number": "954-732-6926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5850 E STILL CIR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063618",
            "telephone_number": "480-219-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTTER-PADILLA",
        "first_name": "JACQUELINE",
        "credential": "PA-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-26",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.