Sipong Patamasucon

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11017 Issued in AZ

Practice address

1801 Mesquite Ave
Lake Havasu City, AZ 86403-5668

Phone

(928) 854-5400

NPI assigned

Mar 18, 2025

Last updated

Mar 18, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Thomas DermatologyGroup PAC ID 9830277136, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kingman Regional Medical Center Hospital, Kingman, AZ, CCN 030055

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Thomas Dermatology

  • Dermatology Physician
  • Las Vegas, NV
  • NPI 1922279496

  AZ

  Medicare reassignment Care Compare group
• Douglas a. Thomas, MD

  dba Thomas Dermatology

  • Dermatology Physician
  • Las Vegas, NV
  • NPI 1891897658
  NPD (past)

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

• Kingman Healthcare, Inc

  dba Kingman Regional Medical Center

  • General Acute Care Hospital
  • Kingman, AZ
  • NPI 1265423917
  Care Compare affiliation

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

{
    "created_epoch": "1742256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1316747256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9097 W POST RD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891482417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 MESQUITE AVE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035668",
            "telephone_number": "928-854-5400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1815 N Stockton Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Kingman",
            "state": "AZ",
            "postal_code": "864014667",
            "country_code": "US",
            "telephone_number": "928-753-9629",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2350 Miracle Mile",
            "address_purpose": "LOCATION",
            "city": "Bullhead City",
            "state": "AZ",
            "postal_code": "864427505",
            "country_code": "US",
            "telephone_number": "928-758-9362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATAMASUCON",
        "first_name": "SIPONG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-03-18",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "11017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Louise Paquette, MS, LISAC
• Elizabeth M Parchoc, LCSW
• Park Place Declarant (Fabulous Hearing)
• Parker Dental
• Kaitlyn Rose Patacca, MD
• Paul Yamaguchi MD PC
• PBW Optometry PC (Riverview Vision Center)
• Debra L Pennington
• Melissa Perez Garcia
• Carol Theresa Perkins

• Physician Assistant in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.