Wanda G Ichiriu, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

8561 Issued in AZ

Practice address

4135 S Power Rd Ste 113
Mesa, AZ 85212-3625

Phone

(480) 626-2444

Fax

(480) 409-2987

NPI assigned

Mar 23, 2007

Sex

Female

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2024 through Oct 1, 2026

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 and National Provider Directory roles.

• Openloop Healthcare Partners PC

  • General Practice Physician
  • Des Moines, IA
  • NPI 1245820661

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1366569246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88747",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532885499",
            "telephone_number": "480-945-6777",
            "fax_number": "480-481-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4135 S POWER RD STE 113",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852123625",
            "telephone_number": "480-626-2444",
            "fax_number": "480-409-2987"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13400 E Shea Blvd",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852595499",
            "country_code": "US",
            "telephone_number": "480-301-8000",
            "fax_number": "480-342-5854",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6900 E Camelback Rd Ste 850",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852512443",
            "country_code": "US",
            "telephone_number": "602-539-5495",
            "fax_number": "480-481-5070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ICHIRIU",
        "first_name": "WANDA",
        "middle_name": "G",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "8561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaime L Ibarrola, MD
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• Icare Home Health Services
• Icare Home Health Services LLC
• Icu423R
• Serena Ide Noumy
• Ideal Rehabilitation PLLC
• Ideal Surgical Center, LLC
• Aya Shion Ienaga, PA-S

• Physician Assistant in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.