Alexis Dianne Pedersen, PA C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

8682 Issued in AZ

Practice address

2902 W Agua Fria Fwy Ste 1000
Phoenix, AZ 85027-3969

Phone

(623) 582-6420

Fax

(623) 582-6720

NPI assigned

Apr 2, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arizona Urology Specialists PLLCGroup PAC ID 5092863852, 84 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Honorhealth Deer Valley Medical Center Hospital, Phoenix, AZ, CCN 030092
• Honorhealth Sonoran Crossing Medical Center Hospital, Phoenix, AZ, CCN 030146
• Abrazo Arrowhead Hospital Hospital, Glendale, AZ, CCN 030094

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Arizona Urology Specialists, PLLC

  • Urology Physician
  • Phoenix, AZ
  • NPI 1740426485
  Medicare reassignment Care Compare group

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

• Honorhealth

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1265063010
  Care Compare affiliation
• Honorhealth

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1528169125
  Care Compare affiliation
• VHS of Arrowhead, Inc

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1326022765
  Care Compare affiliation
• VHS of Arrowhead, Inc.

  • General Acute Care Hospital
  • Peoria, AZ
  • NPI 1801340781
  Care Compare affiliation

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

{
    "created_epoch": "1617321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742515200000",
    "number": "1306425970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10200 GRAND CENTRAL AVE STE 220",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211174366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2902 W AGUA FRIA FWY STE 1000",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850273969",
            "telephone_number": "623-582-6420",
            "fax_number": "623-582-6720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "ALEXIS",
        "middle_name": "DIANNE",
        "credential": "PA C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-02",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "8682",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Dale Peckham
• Dana Robin Peckman, LCSW
• Allison Marie Peckumn, D.O.
• Pectus Services of Arizona, LLC
• Alexander Pedenko, M.D.
• Jennifer Pedersen, CRNA
• Michelle Rose Pedersen, ACNP
• Ali Pederson, PHARM.D.
• Mackenzie Tailleur Pederson
• Pediatras Arizona

• Medical Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.