Tina M Knezevic, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

6217 Issued in AZ

Practice address

13991 W Grand Ave Ste 105
Surprise, AZ 85374-3065

Phone

(800) 233-3264

NPI assigned

Nov 4, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Tina M Duddy 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

At Still Un of HLTH Sciences, Col of Osteo Med, Mesa, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Honorhealth Medical Group, LLCGroup PAC ID 1557274057, 338 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tknezevic9772@evernorth.direct-ci.com

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.

• Honorhealth Medical Group, LLC

  • Primary Care Clinic/Center
  • Peoria, AZ
  • NPI 1043851793
  Medicare reassignment Care Compare group
• Cigna Healthcare of Arizona, Inc

  • Multi-Specialty Clinic/Center
  • Peoria, AZ
  • NPI 1518415397
  NPD
• Honorhealth Medical Group, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1184248411
  NPD
• Honorhealth Medical Group, LLC

  • Family Medicine Physician
  • Scottsdale, AZ
  • NPI 1285338343
  NPD
• Squaw Peak Family Physicians PC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1578590303
  NPD
• Stetson Hills Family Medicine PLC

  • Family Medicine Physician
  • Anthem, AZ
  • NPI 1376996868
  NPD
• Honorhealth Medical Group, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1679876601
  NPD (past)

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

{
    "created_epoch": "1446595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1457724072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13991 W GRAND AVE STE 105",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853743065",
            "telephone_number": "800-233-3264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13991 W GRAND AVE STE 105",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853743065",
            "telephone_number": "800-233-3264"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21731 N 77th Ave",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853822109",
            "country_code": "US",
            "telephone_number": "623-561-3300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6520 W Happy Valley Rd",
            "address_2": "Ste. B103",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853102615",
            "country_code": "US",
            "telephone_number": "623-825-3700",
            "fax_number": "623-825-7601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KNEZEVIC",
        "first_name": "TINA",
        "middle_name": "M",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-04",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "6217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "DUDDY",
            "middle_name": "M",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Medical Physician Assistant in Surprise, AZ
• Providers in Surprise, 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 6, 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.