Individual provider Active NPI

Joseph Pandolfi III, PA-C

  • Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1649964990
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9934 Issued in AZ
Practice address
4730 E Indian School Rd
Phoenix, AZ 85018-5441
Phone
(602) 354-3491
NPI assigned
Jun 7, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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 9934 AZ Primary

Addresses

Primary practice location

4730 E Indian School Rd
Phoenix, AZ 85018-5441

Mailing address

4730 E Indian School Rd
Phoenix, AZ 85018-5441
Phone (602) 354-3491

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, AZ2 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
I20231019001357 NJ Practitioner - Physician Assistant 8426412925 Reassigns benefits to 1 organization
I20240422002283 AZ Practitioner - Physician Assistant 8426412925 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nextcare Arizona I JV LLCGroup PAC ID 7416393194, 297 clinicians

Practice addresses (Care Compare)

1000 N Humphreys St
Suite 104
Flagstaff, AZ 86001-3124
Phone (928) 779-3844

399 S Malpais LN
Suite 100
Flagstaff, AZ 86001-6269
Phone (928) 286-8830

4730 E Indian School Rd
Suite 211
Phoenix, AZ 85018-5410
Phone (602) 354-3491

914 N Scottsdale Rd
Suite 104
Tempe, AZ 85288-2116
Phone (480) 924-8382

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9934AZMDDentist

Interoperability endpoints

  • Direct secure messaging: joseph.pandolfipac.p1@direct.nextcare.nextgenshare.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1686096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1649964990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4730 E INDIAN SCHOOL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850185441",
            "telephone_number": "602-354-3491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 E INDIAN SCHOOL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850185441",
            "telephone_number": "602-354-3491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANDOLFI",
        "first_name": "JOSEPH",
        "name_suffix": "III",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-07",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.