Jacqueline Elizabeth Vercauteren

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

8165 Issued in AZ

Practice address

19555 N 59TH Ave
Glendale, AZ 85308-6813

Phone

(623) 572-3215

NPI assigned

Jul 23, 2020

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

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology and Skin Surgery Specialists of Arizona LLCGroup PAC ID 0547588238, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jvercauteren@affderm.emadirect.md

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.

• Dermatology & Skin Surgery Specialists of Arizona, LLC

  • Dermatology Physician
  • Scottsdale, AZ
  • NPI 1144618943
  Medicare reassignment Care Compare group
• Richard Lee Averitte Jr., PLLC

  • Non-Pharmacy Dispensing Site
  • Anthem, AZ
  • NPI 1619428851
  NPD (past)

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

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1467061697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20401 N 73RD ST",
            "address_2": "STE 230",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852554153",
            "telephone_number": "480-556-0446",
            "fax_number": "623-209-7669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19555 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086813",
            "telephone_number": "623-572-3215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERCAUTEREN",
        "first_name": "JACQUELINE",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-23",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "8165",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Xionelys Velez Lopez, MD
• Ashley Michelle Velez
• Ana Laura Velo Legarreta
• Cameron Ventura, PT
• Lydia Christine Veratti, FAMILY PMHNP-BC
• Verdant Seniors Place LLC
• Christopher J Verdi, M.D.
• Jocelyn Verdugo, DO
• Karen Lee Vergamini, M.C.
• Eugene Verkhovsky, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.