Carlos Ernesto Pena, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4229 Issued in AZ

Practice address

100 E 5TH St
Douglas, AZ 85607-2859

Phone

(520) 364-7659

Fax

(520) 364-8541

NPI assigned

Sep 3, 2008

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

Electronic endpoints 1

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, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bisbee Hospital AssociationGroup PAC ID 5092626168, 69 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Copper Queen Community Hospital Hospital, Bisbee, AZ, CCN 031312

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Bisbee Hospital Association

  • Critical Access Hospital
  • Bisbee, AZ
  • NPI 1518968767
  Medicare reassignment Care Compare group NPD
• Bisbee Hospital Association

  • Rural Health Clinic/Center
  • Hereford, AZ
  • NPI 1245986975
  NPD
• Bisbee Hospital Association

  • Clinic/Center
  • Bisbee, AZ
  • NPI 1568471696
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bisbee Hospital Association

  • Critical Access Hospital
  • Bisbee, AZ
  • NPI 1518968767
  Care Compare affiliation

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1447408570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 F. AVENUE",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "85607",
            "telephone_number": "520-364-1429",
            "fax_number": "520-364-4261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E 5TH ST",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "856072859",
            "telephone_number": "520-364-7659",
            "fax_number": "520-364-8541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "CARLOS",
        "middle_name": "ERNESTO",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-03",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "4229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "carlospena@cqch.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Copper Queen Hospital-Douglas RHC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "100 E 5th St",
            "city": "Douglas",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "856072859",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Katrina Anne Nichols, OD
• Victoria L Ochoa, FNP
• Pamela Oliphant
• Carlos Edward Orendain, PHARM BS
• Zachary Sean Patterson, M.D.
• Kayla Rose Percy, NP
• Bethzaida Perez-Kyles, NP
• Amanda Lea Phillips, RPH, PHARMD
• Pima Heart Physicians, PC
• Pinal Hispanic Council

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; 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.