Individual provider Active NPI

Michael A. Nigbur, PA-C

  • Surgical Physician Assistant
  • Mesa, AZ
National Provider Identifier
1629048970
Registry record updated Mar 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
3443 Issued in AZ
Practice address
4320 E. Presidio Street #101
Mesa, AZ 85215-1165
Phone
(480) 706-9430
Fax
(480) 378-2273
NPI assigned
Jan 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 3443 AZ Primary

Addresses

Primary practice location

4320 E. Presidio Street #101
Mesa, AZ 85215-1165

Mailing address

5155 E. Eagle Drive #20730
Mesa, AZ 85277-3031
Phone (480) 706-9430

Other identifiers 3

IdentifierTypeStateIssuer
P01697311OtherAZRAILROAD MEDICARE
ENROLLEDMedicaidMN
103402MedicaidAZ

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

LicenseStateTypeSpecialty
3443AZMDPhysical Therapist
9230MNMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489536000000",
    "number": "1629048970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5155 E. EAGLE DRIVE #20730",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852773031",
            "telephone_number": "480-706-9430",
            "fax_number": "480-378-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 E. PRESIDIO STREET #101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852151165",
            "telephone_number": "480-706-9430",
            "fax_number": "480-378-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIGBUR",
        "first_name": "MICHAEL",
        "middle_name": "A.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2017-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "3443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01697311",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103402",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.