Patrick W Davis, P.A.C.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA823 Issued in NV

Practice address

724 Kendall LN
Boulder City, NV 89005-1112

Phone

(702) 604-7422

Fax

(702) 549-3178

NPI assigned

Apr 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in NV

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

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.

• Patrick Davis PA-C LTD

  • Surgical Physician Assistant
  • Boulder City, NV
  • NPI 1366702797
  Medicare reassignment Authorized official
• Agata-Venger Partnership

  dba Western Regional Center for Brain and Spine Surgery

  • Neurological Surgery Physician
  • Las Vegas, NV
  • NPI 1093772204
  NPD (past)
• Sunrise Trauma Services LLC

  • Surgical Critical Care Physician
  • Las Vegas, NV
  • NPI 1992770820
  NPD (past)

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571702400000",
    "number": "1417914730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 752287",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891362287",
            "telephone_number": "702-604-7422",
            "fax_number": "702-549-3178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 KENDALL LN",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "890051112",
            "telephone_number": "702-604-7422",
            "fax_number": "702-549-3178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "PATRICK",
        "middle_name": "W",
        "credential": "P.A.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-28",
        "last_updated": "2019-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NV",
            "license": "PA823",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NSBME",
            "identifier": "PA823",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100502933",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "850273",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00206370",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CC535Y",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angelique J. Cross, NP-C
• Michele Lynn Dagenais
• Sean Dame
• Brittney D Davis
• Little Owl Davis
• Nicolle De Guzman
• Nicole Marie Degraff, LCSW
• Carissa Deleeuw, CCC-SLP
• Gregory Brent Dennis, PHD
• Denture & Implant Center

• Physician Assistant in Boulder City, NV
• Providers in Boulder City, NV by specialty
• Physician Assistant in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.