NPIMap

Individual provider Active NPI

Kathleen Diana Debiak, PA-C

  • Physician Assistant
  • Mesa, AZ
National Provider Identifier
1508943671
Registry record updated Sep 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
842-023 Issued in WI
Practice address
2550 N Thunderbird Circle
Ste. 303
Mesa, AZ 85215
Phone
(480) 776-1603
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2012

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 842-023 WI Primary

Addresses

Primary practice location

2550 N Thunderbird Circle
Ste. 303
Mesa, AZ 85215

Mailing address

2550 N Thunderbird Circle
Ste. 303
Mesa, AZ 85215
Phone (480) 776-1603

Other identifiers 2

IdentifierTypeStateIssuer
78781736MedicaidNM
862202MedicaidAZ

Other names 1

  • Kathleen Diana Debiak Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20091104000200 AZ Practitioner - Physician Assistant 2860462009 Reassigns benefits to 1 organization
I20161013001949 CA Practitioner - Physician Assistant 2860462009 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4381AZMDOral and Maxillofacial Surgery (Dentist)
842-023WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc CurrentSince Mar 12, 2019 Accepting new patients
Family Health Centers of San Diego Inc CurrentSince Mar 12, 2019 Accepting new patients
Southwest Emergency Physicians, PLLC Past Accepting new patients
Nextcare Arizona I JV LLC Past Accepting new patients
DHHS PHS Naihs Fort Defiance Hospital Past Accepting new patients
DHHS PHS Naihs Kayenta Health Center Past Accepting new patients

Locations

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346716800000",
    "number": "1508943671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 N THUNDERBIRD CIRCLE",
            "address_2": "STE. 303",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85215",
            "telephone_number": "480-776-1603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 N THUNDERBIRD CIRCLE",
            "address_2": "STE. 303",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85215",
            "telephone_number": "480-776-1603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBIAK",
        "first_name": "KATHLEEN",
        "middle_name": "DIANA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2012-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "842-023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78781736",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "862202",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "DEBIAK",
            "middle_name": "DIANA",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.