Individual provider Active NPI

Judith M Stannard, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Tucson, AZ
National Provider Identifier
1568460566
Registry record updated Mar 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
6935 Issued in AZ
Practice address
6320 N la Cholla Blvd Ste 200
Tucson, AZ 85741-3549
Phone
(520) 382-8200
Fax
(520) 297-3505
NPI assigned
Jul 13, 2005
Last updated
Mar 21, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2019

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001249 CT
Physician Assistant 363A00000X 6935 AZ Primary
Medical Physician Assistant 363AM0700X 001249 CT
Medical Physician Assistant 363AM0700X 6935 AZ
Surgical Physician Assistant 363AS0400X 6935 AZ

Addresses

Primary practice location

6320 N la Cholla Blvd Ste 200
Tucson, AZ 85741-3549

Mailing address

85 Seymour St
Suite 607
Hartford, CT 06106-5501
Phone (860) 549-3210

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
I20190423002455 AZ Practitioner - Physician Assistant 3173710233 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001249CTMDAddiction (Substance Use Disorder) Counselor
6935AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Sky Spine & Sports Medicine PC CurrentSince Sep 19, 2024 Accepting new patients

Locations

6460 E Grant Rd
Unit 30608
Tucson, AZ 85751

6585 N Oracle Rd
Tucson, AZ 85704
Phone (520) 229-2080

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/7527/brand/1/csg/1/fhir/r4
  • Direct secure messaging: judith.stannard.1@7527.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553126400000",
    "number": "1568460566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 SEYMOUR ST",
            "address_2": "SUITE 607",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061065501",
            "telephone_number": "860-549-3210",
            "fax_number": "860-247-3803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6320 N LA CHOLLA BLVD STE 200",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857413549",
            "telephone_number": "520-382-8200",
            "fax_number": "520-297-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANNARD",
        "first_name": "JUDITH",
        "middle_name": "M",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-13",
        "last_updated": "2019-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "001249",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6935",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "001249",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "6935",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "6935",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.