Individual provider Active NPI

Andrea Harris, PA-C

  • Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1649828070
Registry record updated Mar 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
7450 Issued in AZ
Practice address
4212 N 16TH St
Phoenix, AZ 85016-5319
Phone
(602) 263-1200
NPI assigned
Aug 28, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2026

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 7450 AZ Primary

Addresses

Primary practice location

4212 N 16TH St
Phoenix, AZ 85016-5319

Mailing address

15826 E Sunflower Dr Unit 1
Fountain Hills, AZ 85268-3675
Phone (703) 953-5100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20191227001935 AZ Practitioner - Physician Assistant 5890129878 Reassigns benefits to 2 organizations
I20230110003010 TX Practitioner - Physician Assistant 5890129878 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7450AZMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Dec 3, 2022 Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Dec 3, 2022 Accepting new patients
Maricopa County Special Health Care District CurrentSince May 12, 2021 Accepting new patients
District Medical Group, Inc CurrentSince Nov 1, 2019 Accepting new patients
Maricopa County Special Health Care District CurrentSince May 12, 2021 Accepting new patients
District Medical Group, Inc CurrentSince Nov 1, 2019 Accepting new patients

Locations

4212 N 16th St
Phoenix, AZ 85016
Phone (602) 248-4187

33 W Tamarisk St
Phoenix, AZ 85041
Phone (602) 344-6400

2929 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 470-5043

3141 N 3rd Ave
Ste 100
Phoenix, AZ 85013
Phone (602) 914-1520

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

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": "1566950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773792000000",
    "number": "1649828070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15826 E SUNFLOWER DR UNIT 1",
            "city": "FOUNTAIN HILLS",
            "state": "AZ",
            "postal_code": "852683675",
            "telephone_number": "703-953-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 N 16TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165319",
            "telephone_number": "602-263-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "ANDREA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-28",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "7450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.