Individual provider Active NPI

J Guadalupe Gallo Padilla, PA-C

  • Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1447680947
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5490 Issued in AZ
Practice address
13402 N 32ND St Ste 5
Phoenix, AZ 85032-6047
Phone
(602) 569-3999
Fax
(602) 569-3887
NPI assigned
Nov 19, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5490 AZ Primary

Addresses

Primary practice location

13402 N 32ND St Ste 5
Phoenix, AZ 85032-6047

Mailing address

1533 E Willetta St
Phoenix, AZ 85006-2935
Phone (602) 569-3999

Other identifiers 1

IdentifierTypeStateIssuer
870378MedicaidAZ

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20140219000207 AZ Practitioner - Physician Assistant 5991934846 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clinica la Familia PCGroup PAC ID 4082694781, 38 clinicians

Practice addresses (Care Compare)

1315 W Southern Ave
Tempe, AZ 85282-4519
Phone (602) 569-3999

1533 E Willetta St
Phoenix, AZ 85006-2935
Phone (602) 569-3999

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5490AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Kidney Associates PLC Past Accepting new patients

Organizations & group practices 2

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": "1384819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1447680947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1533 E WILLETTA ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062935",
            "telephone_number": "602-569-3999",
            "fax_number": "602-569-3887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13402 N 32ND ST STE 5",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850326047",
            "telephone_number": "602-569-3999",
            "fax_number": "602-569-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLO PADILLA",
        "first_name": "J GUADALUPE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-19",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870378",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.