Chantelle Lassak, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

3064 Issued in AZ

Practice address

6285 S Higley Rd
Gilbert, AZ 85298

Phone

(480) 460-4949

Fax

(480) 490-5858

NPI assigned

Sep 28, 2006

Last updated

Oct 14, 2021By 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 names 1

• Chantelle Botkin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FDGBAA

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.

• Desert Shores Pediatrics

  • Pediatrics Physician
  • Gilbert, AZ
  • NPI 1124386487
  NPD

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634169600000",
    "number": "1457443418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6285 S HIGLEY RD",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852984262",
            "telephone_number": "480-460-4949",
            "fax_number": "480-460-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6285 S HIGLEY RD",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85298",
            "telephone_number": "480-460-4949",
            "fax_number": "480-490-5858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "965 W Chandler Heights Rd",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852485724",
            "country_code": "US",
            "telephone_number": "480-460-4949",
            "fax_number": "480-460-5858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LASSAK",
        "first_name": "CHANTELLE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "3064",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "3064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHANTELLE",
            "last_name": "BOTKIN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tara Lynn Larson, MS OTR/L
• Zenda P Lasao, PA-C
• Matthew Lasinis
• Jenna Laskoski, PA-C
• Micah Lasley, PA-C
• Tina C Latona Besthoff, SLPA
• Linda Lin Lau, MD
• Kristina Laugen, COTA/L
• Jacqueline Lauren Lauko, LPC
• Seren Lauritzen, ED.S.

• Medical Physician Assistant in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.