Jeanette C. Bannister, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5411 Issued in AZ

Practice address

13677 W McDowell Rd
Goodyear, AZ 85395-2635

Phone

(623) 536-4200

Fax

(623) 935-0304

NPI assigned

Nov 17, 2011

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

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 1

Other names 1

• Jeanette C. Alcorn Former name

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, 2011

Medicare assignment

May accept Medicare assignment

Group practices

Regency Skin Institute PLLCGroup PAC ID 5193097665, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations (25 of 38)

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.

• Regency Skin Institute PLLC

  • MOHS-Micrographic Surgery Physician
  • Surprise, AZ
  • NPI 1932630563
  Medicare reassignment Care Compare group
• Honorhealth

  dba HonorHealth Contract Providers

  • Surgery Physician
  • Scottsdale, AZ
  • NPI 1801092564
  Medicare reassignment NPD
• Acute Care Surgical Specialists, LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Phoenix, AZ
  • NPI 1225311871
  Medicare reassignment
• Honorhealth Ambulatory

  dba HonorHealth Research Institute

  • Hematology & Oncology Physician
  • Scottsdale, AZ
  • NPI 1407050917
  Medicare reassignment
• Mussman, PLLC

  • Plastic Surgery Physician
  • Phoenix, AZ
  • NPI 1821539156
  Medicare reassignment
• Neurocritical Care and Stroke of Arizona PLLC

  • Vascular Neurology Physician
  • Phoenix, AZ
  • NPI 1649561580
  Medicare reassignment
• Nextcare Arizona LLC

  dba NextCare Urgent Care

  • Urgent Care Clinic/Center
  • Tempe, AZ
  • NPI 1043371826
  Medicare reassignment
• Regency Ambulatory Surgery Center One, LLC

  • Ambulatory Surgical Clinic/Center
  • Surprise, AZ
  • NPI 1073155834
  Medicare reassignment
• Regency Reconstruction PLLC

  • Plastic and Reconstructive Surgery Physician
  • Phoenix, AZ
  • NPI 1972086924
  Medicare reassignment
• Honorhealth

  dba HonorHealth Tina's Treasures

  • Prosthetic/Orthotic Supplier
  • Peoria, AZ
  • NPI 1386456762
  NPD
• Honorhealth Ambulatory

  • Family Medicine Physician
  • Gilbert, AZ
  • NPI 1841861143
  NPD
• Honorhealth Ambulatory

  • Emergency Medicine Physician
  • Mesa, AZ
  • NPI 1891518130
  NPD

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

{
    "created_epoch": "1321488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1427325638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9250 N 3RD ST STE 3015",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850202425",
            "telephone_number": "602-996-4747",
            "fax_number": "602-953-5466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13677 W MCDOWELL RD",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952635",
            "telephone_number": "623-536-4200",
            "fax_number": "623-935-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANNISTER",
        "first_name": "JEANETTE",
        "middle_name": "C.",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10001343A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "827411",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANETTE",
            "last_name": "ALCORN",
            "middle_name": "C.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Banner Urgent Care Services, LLC
• Banner Urgent Care Services, LLC
• Prachi Bansal, M.D.
• Sarahi Barajas
• Barbara Goldmunz DC PC
• Nicole L Barbaro, PA C
• Barnet Dulaney Perkins Eye Center, PC (American Vision Partners)

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

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