Individual provider Active NPI

Amadou B Jallow, PA-C

  • Physician Assistant
  • Glendale, AZ
National Provider Identifier
1497299648
Registry record updated Dec 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
6589 Issued in AZ
Practice address
20100 N 51St Ave
Suite F620
Glendale, AZ 85308-5125
Phone
(623) 376-6328
NPI assigned
Dec 7, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 6589 AZ Primary

Addresses

Primary practice location

20100 N 51St Ave
Suite F620
Glendale, AZ 85308-5125

Mailing address

20100 N 51St Ave
Suite F620
Glendale, AZ 85308-5125
Phone (623) 376-6328

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
I20161229000381 AZ Practitioner - Physician Assistant 8224319561 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Banner Physician Specialists Arizona LLCGroup PAC ID 6204002272, 371 clinicians

Practice addresses (Care Compare)

10401 W Thunderbird Blvd
Sun City, AZ 85351-3004
Phone (623) 832-4000

14502 W Meeker Blvd
Banner Health Clinic
Sun City West, AZ 85375-5282
Phone (623) 524-4000

5555 W Thunderbird Rd
Banner Health Clinic
Glendale, AZ 85306-4622
Phone (602) 865-5555

9165 W Thunderbird Rd
Suite 200
Peoria, AZ 85381-4847
Phone (623) 285-1120

Hospital & facility affiliations

  • Banner Thunderbird Medical Center Hospital, Glendale, AZ, CCN 030089
  • Banner del E. Webb Medical Center Hospital, Sun City West, AZ, CCN 030093
  • Banner Boswell Medical Center Hospital, Sun City, AZ, CCN 030061

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
6589AZMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Physician Specialists Arizona LLC CurrentSince Jul 28, 2022 Accepting new patients
Banner Physician Specialists Arizona LLC CurrentSince Jul 28, 2022 Accepting new patients
Banner Physician Specialists Arizona LLC Current Accepting new patients

Locations

7701 W Aspera Blvd
Ste 102
Glendale, AZ 85308
Phone (623) 248-2100

9165 W Thunderbird Rd
Ste 200
Peoria, AZ 85381
Phone (623) 285-1120

10401 W Thunderbird Blvd
Sun City, AZ 85351
Phone (623) 815-7690

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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": "1481068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481068800000",
    "number": "1497299648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20100 N 51ST AVE",
            "address_2": "SUITE F620",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853085125",
            "telephone_number": "623-376-6328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20100 N 51ST AVE",
            "address_2": "SUITE F620",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853085125",
            "telephone_number": "623-376-6328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JALLOW",
        "first_name": "AMADOU",
        "middle_name": "B",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-12-07",
        "last_updated": "2016-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.