Active NPI
Jon Patterson, PHYSICIAN ASSISTANT
- Medical Physician Assistant
- Phoenix, AZ
National Provider Identifier
1508188756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 4605
- Practice address
- 2222 E Highland Ave
Ste 425
Phoenix, AZ 85016-4881 - Phone
- (602) 667-6640
- Fax
- (602) 522-9914
- NPI assigned
- Feb 15, 2010
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 4605 | AZ | Primary |
Addresses
Primary practice location
2222 E Highland Ave
Ste 425
Phoenix, AZ 85016-4881
Mailing address
PO Box 29870
Phoenix, AZ 85038-9870
Phone (602) 772-3800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 450007 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4605 | AZ | MD | Counseling Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optumcare New Mexico LLC | Current | Accepting new patients |
Locations
5150 Journal Center Blvd NE
Fl 3
Albuquerque, NM 87109
Phone (505) 262-3212
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 and National Provider Directory roles.
-
- Family Medicine Physician
- Albuquerque, NM
- NPI 1124053210
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405468800000",
"number": "1508188756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 29870",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850389870",
"telephone_number": "602-772-3800",
"fax_number": "602-772-3801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2222 E HIGHLAND AVE",
"address_2": "STE 425",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850164881",
"telephone_number": "602-667-6640",
"fax_number": "602-522-9914"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTERSON",
"first_name": "JON",
"credential": "PHYSICIAN ASSISTANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-15",
"last_updated": "2014-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AZ",
"license": "4605",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "450007",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.