Active NPI
Walter Desha, PA
- Surgical Physician Assistant
- Rancho Mirage, CA
National Provider Identifier
1497738132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 15929
- Practice address
- 39000 Bob Hope Dr
K-108
Rancho Mirage, CA 92270-3221 - Phone
- (760) 595-4330
- NPI assigned
- Nov 28, 2005
- Last updated
- Apr 20, 2016
- 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 15929 | CA | Primary |
Addresses
Primary practice location
39000 Bob Hope Dr
K-108
Rancho Mirage, CA 92270-3221
Mailing address
39000 Bob Hope Dr
K-108
Rancho Mirage, CA 92270-3221
Phone (760) 595-4330
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 |
|---|---|---|---|
| 15929 | CA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eisenhower Medical Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Eisenhower Health
- General Acute Care Hospital
- Rancho Mirage, CA
- NPI 1013981554
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461110400000",
"number": "1497738132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39000 BOB HOPE DR",
"address_2": "K-108",
"city": "RANCHO MIRAGE",
"state": "CA",
"postal_code": "922703221",
"telephone_number": "760-595-4330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39000 BOB HOPE DR",
"address_2": "K-108",
"city": "RANCHO MIRAGE",
"state": "CA",
"postal_code": "922703221",
"telephone_number": "760-595-4330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESHA",
"first_name": "WALTER",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-28",
"last_updated": "2016-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "CA",
"license": "15929",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Mirage, CA
- Desert View Homecare LLC
- Desert Vision Center Medical Associates, Inc
- Desert Vision Surgery Center, LLC
- Desert Wellness Psychiatry, Inc
- Clara Christine Desha, NP
- Vincent Patrick Devlin Jr., DO, MHS
- Marianne K Dezelan, PAC
- Abigail Rose Dezern
- Massoud G Dezfuli, D.O.
- DFDD Clinical Services (We Care Dental Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.