Individual provider Active NPI

Devyn Alexandria Wengraf

  • Gerontology Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1487336293
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
299049 Issued in AZ
Practice address
500 W Thomas Rd Ste 400
Phoenix, AZ 85013-4238
Phone
(602) 406-3874
Fax
(602) 406-2335
NPI assigned
Aug 1, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WC0200X RN197419 AZ
Gerontology Nurse Practitioner 363LG0600X 299049 AZ Primary

Addresses

Primary practice location

500 W Thomas Rd Ste 400
Phoenix, AZ 85013-4238

Mailing address

PO Box 33269
Phoenix, AZ 85067-3269
Phone (602) 406-4786

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
I20231030003457 AZ Practitioner - Nurse Practitioner 8527414366 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Joseph's Hospital and Medical CenterGroup PAC ID 6709863178, 23 clinicians

Practice addresses (Care Compare)

350 W Thomas Rd
Phoenix, AZ 85013-4409
Phone (602) 406-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN197419AZMDCritical Care Medicine Registered Nurse
299049AZMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sjhmc Physician Services Single Specialty CurrentSince Nov 1, 2023 Accepting new patients
St. Joseph's Hospital and Medical Center Single Specialty CurrentSince Nov 1, 2023 Accepting new patients
St Josephs Pathology Single Specialty Current Accepting new patients

Locations

350 W Thomas Rd
Phoenix, AZ 85013
Phone (480) 339-5001

500 W Thomas Rd
Ste 680
Phoenix, AZ 85013
Phone (602) 406-6017

500 W Thomas Rd
Ste 400
Phoenix, AZ 85013
Phone (602) 406-3874

File 56765
Los Angeles, CA 90074

Organizations & group practices 3

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1690848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1487336293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33269",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850673269",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W THOMAS RD STE 400",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134238",
            "telephone_number": "602-406-3874",
            "fax_number": "602-406-2335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENGRAF",
        "first_name": "DEVYN",
        "middle_name": "ALEXANDRIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-01",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "AZ",
            "license": "RN197419",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AZ",
            "license": "299049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.