Individual provider Active NPI

Laura Elise Juarez, PA-C

  • Surgical Physician Assistant
  • Tulsa, OK
National Provider Identifier
1407398639
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
56826 Issued in CA
Practice address
1265 S Utica Ave Ste 105
Tulsa, OK 74104-4243
Phone
(918) 592-0999
Fax
(918) 592-1021
NPI assigned
Nov 4, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 000919 PR
Medical Physician Assistant 363AM0700X UT
Surgical Physician Assistant 363AS0400X 4749 OK
Surgical Physician Assistant 363AS0400X 56826 CA Primary

Addresses

Primary practice location

1265 S Utica Ave Ste 105
Tulsa, OK 74104-4243

Mailing address

PO Box 615
Dorado, PR 00646-0615
Phone (801) 362-6791

Other practice location 1

Dr Jose Celso Barbosa Drive
Recinto Ciencias Medicas, UPR
San Juan, PR 00921
Phone (801) 362-6791

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, OK2 enrollments
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171003006036 UT Practitioner - Physician Assistant 3577838499 Reassigns benefits to 1 organization
I20220315000626 OK Practitioner - Physician Assistant 3577838499 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
56826CAMDGeneral Practice Dentistry
4749OKMDEmergency Medicine Physician
000919PRMDOccupational Therapist
022951NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Aug 21, 2017 Accepting new patients
Ihc Health Services Inc CurrentSince Aug 21, 2017 Accepting new patients
Integris Cardiovascular Physicians LLC Past Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

400 C St
Salt Lake Cty, UT 84143
Phone (435) 688-4080

5121 S Cottonwood St
Salt Lake Cty, UT 84107
Phone (801) 408-8998

Interoperability endpoints

  • Direct secure messaging: ljuarez435964@direct.ynhh.org
  • Direct secure messaging: ljuarez1090027@ahs.direct-ci.com
  • Direct secure messaging: ljuarez412027@direct-ehr-ssmhc.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1407398639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 615",
            "city": "DORADO",
            "state": "PR",
            "postal_code": "006460615",
            "telephone_number": "801-362-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 S UTICA AVE STE 105",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044243",
            "telephone_number": "918-592-0999",
            "fax_number": "918-592-1021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Dr Jose Celso Barbosa Drive",
            "address_2": "Recinto Ciencias Medicas, UPR",
            "address_purpose": "LOCATION",
            "city": "San Juan",
            "state": "PR",
            "postal_code": "00921",
            "country_code": "US",
            "telephone_number": "801-362-6791",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUAREZ",
        "first_name": "LAURA",
        "middle_name": "ELISE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-04",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PR",
            "license": "000919",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OK",
            "license": "4749",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "56826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.