NPIMap

Individual provider Active NPI

Daniel Anthony Indilicato, PA

  • Surgical Physician Assistant
  • Gilbert, AZ
National Provider Identifier
1659395655
Registry record updated Apr 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
4385 Issued in AZ
Practice address
1094 S Gilbert Rd
Suite 203
Gilbert, AZ 85296-3445
Phone
(480) 882-4000
NPI assigned
Jul 26, 2006
Last updated
Apr 27, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2010

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 4385 AZ Primary

Addresses

Primary practice location

1094 S Gilbert Rd
Suite 203
Gilbert, AZ 85296-3445

Mailing address

PO Box 8131
Scottsdale, AZ 85252-8131
Phone (480) 882-4000

Other identifiers 2

IdentifierTypeStateIssuer
000494574001OtherNYBLUE SHIELD
040511001092OtherNYFIDELIS CARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090602000134 AZ Practitioner - Physician Assistant 7113904145 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neurosurgical Associates LTDGroup PAC ID 8820993967, 76 clinicians

Practice addresses (Care Compare)

1200 N Beaver St
Flagstaff, AZ 86001-3118
Phone (928) 779-3366

1215 N Beaver St
Suite 203
Flagstaff, AZ 86001-3126
Phone (928) 773-2249

269 S Candy LN
Cottonwood, AZ 86326-4158
Phone (928) 639-6000

3420 S Mercy Rd
Suite 221
Gilbert, AZ 85297-0424
Phone (480) 681-7134

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Neurosurgical Associates, LTD CurrentSince Dec 1, 2017 Accepting new patients
Neurosurgical Associates, LTD CurrentSince Dec 1, 2017 Accepting new patients
Honorhealth Ambulatory CurrentSince Mar 9, 2013 Accepting new patients
Honorhealth Ambulatory CurrentSince Mar 9, 2013 Accepting new patients
Reddy Gi Associates Past Accepting new patients
Spooner Phoenix Physical Therapy, Inc. Past Accepting new patients
R. Ryan Rawlings, DO, PLC PastSince Sep 13, 2017 Accepting new patients
KC's Physical Therapy LLC Past Accepting new patients
Vishal Chaurasia MD PC Past Accepting new patients

Locations

3420 S Mercy Rd
Ste 221
Gilbert, AZ 85297
Phone (480) 553-7993

19829 N 27th Ave
Phoenix, AZ 85027
Phone (602) 879-5720

250 E Dunlap Ave
Phoenix, AZ 85020
Phone (480) 331-6721

2500 W Utopia Rd
Ste 100
Phoenix, AZ 85027
Phone (623) 683-4462

2910 N 3rd Ave
#200
Phoenix, AZ 85013
Phone (602) 406-3008

10510 N 92nd St
Ste 200
Scottsdale, AZ 85258
Phone (480) 323-1250

7400 E Osborn Rd
Scottsdale, AZ 85251
Phone (480) 481-4000

9003 E Shea Blvd
Scottsdale, AZ 85260
Phone (480) 323-3383

Organizations & group practices 11

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272326400000",
    "number": "1659395655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8131",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852528131",
            "telephone_number": "480-882-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1094 S GILBERT RD",
            "address_2": "SUITE 203",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852963445",
            "telephone_number": "480-882-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INDILICATO",
        "first_name": "DANIEL",
        "middle_name": "ANTHONY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2010-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "4385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000494574001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS CARE",
            "identifier": "040511001092",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

Verify at the official NPI Registry.