Corey Wayne Deberry-Seguine, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6480 Issued in AZ

Practice address

4915 E Baseline Rd Ste 112
Gilbert, AZ 85234-2966

Phone

(480) 626-6600

Fax

(480) 626-6604

NPI assigned

Oct 3, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Corey Wayne Seguine Professional name

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

San Tan Allergy and Asthma PCGroup PAC ID 1658309521, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• San Tan Allergy and Asthma PC

  • Allergy & Immunology Physician
  • Gilbert, AZ
  • NPI 1124240510
  Medicare reassignment Care Compare group
• Deseret Family Practice, LTD.

  • Multi-Specialty Clinic/Center
  • Mesa, AZ
  • NPI 1215960638
  NPD (past)
• Northern Arizona Pain Services LLC

  • Family Nurse Practitioner
  • Payson, AZ
  • NPI 1902152556
  NPD (past)

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

{
    "created_epoch": "1475452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672790400000",
    "number": "1669921524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4915 E BASELINE RD STE 112",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342966",
            "telephone_number": "480-626-6600",
            "fax_number": "480-626-6604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4915 E BASELINE RD STE 112",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342966",
            "telephone_number": "480-626-6600",
            "fax_number": "480-626-6604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBERRY-SEGUINE",
        "first_name": "COREY",
        "middle_name": "WAYNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-03",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@santanallergy.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4915 E Baseline Rd Ste 112",
            "city": "Gilbert",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852342966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "COREY",
            "last_name": "SEGUINE",
            "middle_name": "WAYNE",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Mark William Deardorff, M.D.
• Kristen Rita Dearing, DNP, FNP-BC
• Iona Dease, LCSW
• Courtney Deaver
• Collin Debarbrie, DPT, ATC
• Paul Debey, DPT
• Cherro Deblassie, RN, BSN, IBCLC
• Tracy Marie Debois
• Maria Cristina Decarvalho, LMSW
• Anna Marie Decker, FNP-C

• Physician Assistant in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.