Simon Pedro Jacquez, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

9856 Issued in AZ

Practice address

6211 N 35TH Ave
Phoenix, AZ 85017-1415

Phone

(602) 242-5000

Fax

(480) 605-2291

NPI assigned

Jul 27, 2023

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, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

I Am Wellness Az LLCGroup PAC ID 8123497344, 35 clinicians

Progressive Pain Management IncGroup PAC ID 1153490727, 32 clinicians

Ohana Kids and Family Kare LLCGroup PAC ID 5193156438, 3 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• I Am Wellness Az LLC

  • Adult Medicine Physician
  • Chandler, AZ
  • NPI 1184354532
  Medicare reassignment Care Compare group
• Ohana Kids & Family Kare LLC

  • Family Medicine Physician
  • Mesa, AZ
  • NPI 1003356320
  Medicare reassignment Care Compare group
• Advanced Minimally Invasive Surgical

  • Surgery Physician
  • Phoenix, AZ
  • NPI 1295056919
  Medicare reassignment
• Hope Diabetes Center, LLC

  dba Clinica Esperanza-Hope Primary Care, LLC

  • Internal Medicine Physician
  • Mesa, AZ
  • NPI 1104865757
  Medicare reassignment
• Maria Gonzalez Berlari, MD LLC

  dba GB Family Care, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1699025981
  Medicare reassignment
• Michael F Esber DPM PC

  • Foot Surgery Podiatrist
  • Sun City West, AZ
  • NPI 1902907504
  Medicare reassignment
• Progressive Pain Management Inc

  • Interventional Pain Medicine Physician
  • Casa Grande, AZ
  • NPI 1881866754
  Care Compare group

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

{
    "created_epoch": "1690416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1336820976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6211 N 35TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850171415",
            "telephone_number": "602-242-5000",
            "fax_number": "480-605-2291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6211 N 35TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850171415",
            "telephone_number": "602-242-5000",
            "fax_number": "480-605-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUEZ",
        "first_name": "SIMON",
        "middle_name": "PEDRO",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-27",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "9856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Pescatore Jacobson, PA-C
• Traci Jacobson
• Nikki Christina Jacobus
• Deborah Jacoby, FNP
• David Joseph Jacofsky, M.D.
• Jacquie Jensen, MSW, Lisac
• Jade Health and Wellness LLC
• Caroline Jadlowiec, M.D.
• Jae Chung Family Dental (JC Family Dental)
• Jennifer Lee Jaeckel, LICSW

• 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 Jul 27, 2023; 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.