Active NPI
Lillian M Berry, P.A.
- Medical Physician Assistant
- Phoenix, AZ
National Provider Identifier
1619947850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 1959
- Practice address
- 444 W Osborn Rd
Suite 200
Phoenix, AZ 85013-3814 - Phone
- (602) 230-1400
- Fax
- (602) 230-7676
- NPI assigned
- Jan 23, 2006
- Sex
- Female
- 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 | 1959 | AZ | Primary |
Addresses
Primary practice location
444 W Osborn Rd
Suite 200
Phoenix, AZ 85013-3814
Mailing address
PO Box 29870
Phoenix, AZ 85038-9870
Phone (602) 772-3805
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 454025 | Medicaid | AZ | |
| 3Z3956 | Other | AZ | HEALTHNET |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1959 | AZ | MD | Addiction (Substance Use Disorder) Psychologist |
Organizations & group practices 3
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.
-
- Physical Medicine & Rehabilitation Physician
- Phoenix, AZ
- NPI 1659796985
-
- Multi-Specialty Clinic/Center
- Goodyear, AZ
- NPI 1912979964
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394755200000",
"number": "1619947850",
"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": "602-772-3805",
"fax_number": "602-772-3801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "444 W OSBORN RD",
"address_2": "SUITE 200",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850133814",
"telephone_number": "602-230-1400",
"fax_number": "602-230-7676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERRY",
"first_name": "LILLIAN",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-23",
"last_updated": "2014-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AZ",
"license": "1959",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "454025",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "3Z3956",
"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 Mar 14, 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.