Individual provider Active NPI

Jay Gary Bernstein, D.O.

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1649233396
Registry record updated Jan 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1936 Issued in AZ
Practice address
4220 W Bethany Home Rd
Phoenix, AZ 85019-1808
Phone
(623) 281-1258
Fax
(623) 281-1260
NPI assigned
Apr 11, 2006
Last updated
Jan 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1936 AZ Primary

Addresses

Primary practice location

4220 W Bethany Home Rd
Phoenix, AZ 85019-1808

Mailing address

102 Woodmont Blvd Ste 600
Nashville, TN 37205-5250

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050510000320 AZ Practitioner - General Practice 6800836818 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
1936AZMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Archwell Health Professional Services of Arizona, LLC CurrentSince Jan 9, 2023 Accepting new patients
Desert Valley Radiology, PLC PastSince Dec 12, 2016 Accepting new patients

Locations

4315 E Main St
Mesa, AZ 85205
Phone (480) 654-0260

4220 W Bethany Home Rd
Phoenix, AZ 85019
Phone (623) 281-1258

102 Woodmont Blvd
Ste 600
Nashville, TN 37205

Organizations & group practices 2

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": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673568000000",
    "number": "1649233396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WOODMONT BLVD STE 600",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372055250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4220 W BETHANY HOME RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850191808",
            "telephone_number": "623-281-1258",
            "fax_number": "623-281-1260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNSTEIN",
        "first_name": "JAY",
        "middle_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "1936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.