NPIMap

Individual provider Active NPI

Roberto A Paredes, NP

  • Family Nurse Practitioner
  • Prescott, AZ
National Provider Identifier
1306616768
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
307012 Issued in AZ
Practice address
3120 Clearwater Dr
Prescott, AZ 86305-7131
Phone
(928) 771-3704
Fax
(928) 771-0434
NPI assigned
Jan 8, 2024
Last updated
Feb 17, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 307012 AZ Primary

Addresses

Primary practice location

3120 Clearwater Dr
Prescott, AZ 86305-7131

Mailing address

PO Box 10880
Prescott, AZ 86304-0880
Phone (602) 406-4786

Other identifiers 1

IdentifierTypeStateIssuer
211039MedicaidAZ

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
I20240730001728 AZ Practitioner - Nurse Practitioner 7618414467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3120 Clearwater Dr
Prescott, AZ 86305-7131
Phone (928) 771-3704

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Sep 1, 2024 Accepting new patients
Yavapai Regional Medical Center Physician Care LLC Current Accepting new patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Sep 1, 2024 Accepting new patients
Prescott Gastroenterology Past Accepting new patients

Locations

3120 Clearwater Dr
Prescott, AZ 86305
Phone (928) 445-4818

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.

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": "1704672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1306616768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 CLEARWATER DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863057131",
            "telephone_number": "928-771-3704",
            "fax_number": "928-771-0434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAREDES",
        "first_name": "ROBERTO",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-08",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "307012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "211039",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.