Active NPI
Brian Wortzel, PA-C
- Physician Assistant
- Mesa, AZ
National Provider Identifier
1467692897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 3160
- Practice address
- 4540 E Baseline Rd
115
Mesa, AZ 85206-4613 - Phone
- (480) 306-6405
- Fax
- (480) 361-6108
- NPI assigned
- Feb 25, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 3160 | AZ | Primary |
Addresses
Primary practice location
4540 E Baseline Rd
115
Mesa, AZ 85206-4613
Mailing address
4540 E Baseline Rd Ste 115
Mesa, AZ 85206-4617
Phone (480) 306-6405
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Z170907 | Other | AZ | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3160 | AZ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414972800000",
"number": "1467692897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4540 E BASELINE RD STE 115",
"city": "MESA",
"state": "AZ",
"postal_code": "852064617",
"telephone_number": "480-306-6405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4540 E BASELINE RD",
"address_2": "115",
"city": "MESA",
"state": "AZ",
"postal_code": "852064613",
"telephone_number": "480-306-6405",
"fax_number": "480-361-6108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WORTZEL",
"first_name": "BRIAN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-25",
"last_updated": "2014-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "3160",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "Z170907",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.