NPIMap

Individual provider Active NPI

Jismi Theeyattuveli, NP

  • Nurse Practitioner
  • Mesa, AZ
National Provider Identifier
1285229534
Registry record updated Nov 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
254316 Issued in AZ
Practice address
51 S 48TH St
Mesa, AZ 85206-1250
Phone
(480) 832-8333
NPI assigned
Mar 8, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 138064 AZ
Nurse Practitioner 363L00000X 254316 AZ Primary

Addresses

Primary practice location

51 S 48TH St
Mesa, AZ 85206-1250

Mailing address

4291 E Lexington Ave
Gilbert, AZ 85234-0729
Phone (480) 310-8524

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
I20210826000869 AZ Practitioner - Nurse Practitioner 0446655625 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Veracian Healthcare PLCGroup PAC ID 2769535582, 2 clinicians
Pioneer Hospitalists, PLLCGroup PAC ID 0941290290, 50 clinicians

Practice addresses (Care Compare)

3555 S Val Vista Dr
Gilbert, AZ 85297-7323
Phone (480) 275-4998

475 S Dobson Rd
Chandler, AZ 85224-5605
Phone (888) 488-7640

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
138064AZMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Alante Primary Care W LLC CurrentSince Dec 15, 2024 Accepting new patients
Pioneer Hospitalists, PLLC CurrentSince Sep 4, 2023 Accepting new patients
District Medical Group, Inc Current Accepting new patients
Alante Primary Care and Palliative Services LLC CurrentSince Feb 1, 2022 Accepting new patients
Veracian Healthcare PLC CurrentSince Oct 17, 2021 Accepting new patients
District Medical Group, Inc CurrentSince May 1, 2023 Accepting new patients
Valley Geriatric Associates PLLC CurrentSince Sep 9, 2025 Accepting new patients
Pain and Palliative Associates of Arizona CurrentSince Sep 9, 2025 Accepting new patients
District Medical Group, Inc CurrentSince May 1, 2023 Accepting new patients
Evolution Healthcare Management LLC PastSince Jul 1, 2021 Accepting new patients

Locations

3100 W Ray Rd
Ste 201
Chandler, AZ 85226
Phone (269) 312-1446

1955 W Frye Rd
Chandler, AZ 85224
Phone (480) 507-2961

825 S 94th St
Chandler, AZ 85224
Phone (480) 361-6636

3555 S Val Vista Dr
Gilbert, AZ 85297
Phone (480) 434-4356

3011 S Lindsay Rd
Ste 115
Gilbert, AZ 85295
Phone (602) 249-8578

1301 S Crismon Rd
Mesa, AZ 85209
Phone (480) 358-6300

9130 E Elliot Rd
Mesa, AZ 85212
Phone (480) 410-4500

5358 E Baseline Rd
Mesa, AZ 85206
Phone (480) 630-3005

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

2525 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 344-1015

4202 N 20th Ave
Phoenix, AZ 85015
Phone (602) 264-3824

3811 E Bell Rd
Ste 111
Phoenix, AZ 85032
Phone (602) 675-2585

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

8502 E Princess Dr
Ste 200E
Scottsdale, AZ 85255
Phone (480) 631-4978

17490 N 93rd St
Scottsdale, AZ 85255
Phone (480) 588-5386

Interoperability endpoints

  • Direct secure messaging: jtheeyattuveli256110@direct.valleywisehealth.org

Organizations & group practices 10

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 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1615161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668384000000",
    "number": "1285229534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4291 E LEXINGTON AVE",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852340729",
            "telephone_number": "480-310-8524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 S 48TH ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061250",
            "telephone_number": "480-832-8333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEEYATTUVELI",
        "first_name": "JISMI",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-08",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "138064",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "254316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.