NPIMap

Individual provider Active NPI

Larissa Dohn Wiley, PA-C

  • Physician Assistant
  • Scottsdale, AZ
National Provider Identifier
1679056147
Registry record updated Mar 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
7140 Issued in AZ
Practice address
8705 E McDowell Rd
Scottsdale, AZ 85257-3909
Phone
(480) 882-4545
Fax
(480) 946-6997
NPI assigned
Sep 11, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 7140 AZ
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X 7140 AZ Primary

Addresses

Primary practice location

8705 E McDowell Rd
Scottsdale, AZ 85257-3909

Mailing address

7500 N Dreamy Draw Dr Ste 145
Phoenix, AZ 85020-4668
Phone (480) 882-4545

Other identifiers 1

IdentifierTypeStateIssuer
435328MedicaidAZ

Other names 1

  • Larissa Marie Dohn Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, SD2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181115001568 AZ Practitioner - Physician Assistant 3274887955 Reassigns benefits to 3 organizations
I20240710004041 SD Practitioner - Physician Assistant 3274887955 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Monument Health Rapid City Hospital IncGroup PAC ID 6002729506, 560 clinicians

Practice addresses (Care Compare)

1303 N Lacrosse St
Rapid City, SD 57701-6956
Phone (605) 755-6600

2116 Jackson Blvd
Rapid City, SD 57702-3495
Phone (605) 755-3900

2526 Elderberry Blvd
Rapid City, SD 57703-6589
Phone (605) 755-2273

353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone (605) 755-8109

375 Berky Dr
Box Elder, SD 57719-8060
Phone (605) 755-2273

Hospital & facility affiliations

  • Monument Health Rapid City Hospital Hospital, Rapid City, SD, CCN 430077

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1161SDMDProfessional Counselor
7140AZMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Rapid City Hospital Inc CurrentSince May 14, 2024 Accepting new patients
Neighborhood Outreach Access to Health Multi-Specialty CurrentSince Jan 6, 2020 Accepting new patients
Honorhealth Urgent Care, LLC Multi-Specialty CurrentSince Feb 26, 2024 Accepting new patients
Honorhealth Urgent Care, LLC CurrentSince Feb 26, 2024 Accepting new patients
District Medical Group, Inc Multi-Specialty CurrentSince Sep 1, 2018 Accepting new patients
Maricopa County Special Health Care District CurrentSince Sep 1, 2018 Accepting new patients
Neighborhood Outreach Access to Health CurrentSince Jan 6, 2020 Accepting new patients
Maricopa County Special Health Care District Multi-Specialty CurrentSince Sep 1, 2018 Accepting new patients
Monument Health Rapid City Hospital, Inc CurrentSince May 14, 2024 Accepting new patients
District Medical Group, Inc Multi-Specialty CurrentSince Sep 1, 2018 Accepting new patients
Monument Health Rapid City Hospital, Inc. Past Accepting new patients
District Medical Group, Inc Multi-Specialty Past Accepting new patients

Locations

3648 W Anthem Way
Bldg A100C
Anthem, AZ 85086
Phone (623) 434-6444

11851 N 51st Ave
Ste B110
Glendale, AZ 85304

6206 W Bell Rd
Glendale, AZ 85308
Phone (602) 978-5999

5141 W Lamar Rd
Glendale, AZ 85301
Phone (602) 506-6767

5130 W Baseline Rd
Ste 102
Laveen, AZ 85339
Phone (602) 237-0039

7500 N Dreamy Draw Dr
Ste 145
Phoenix, AZ 85020

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

2525 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 344-1015

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

20440 N 27th Ave
Phoenix, AZ 85027

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

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

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

2025 W Northern Ave
Phoenix, AZ 85021
Phone (602) 344-5253

8705 E McDowell Rd
Scottsdale, AZ 85257

725 S Rural Rd
Ste 120
Tempe, AZ 85288
Phone (480) 214-0622

375 Berky Dr
Box Elder, SD 57719

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

2116 Jackson Blvd
Rapid City, SD 57702
Phone (605) 755-3300

1303 N Lacrosse St
Rapid City, SD 57701
Phone (605) 755-6600

2526 Elderberry Blvd
Rapid City, SD 57703

Interoperability endpoints

  • Direct secure messaging: lwiley607514@direct.ochin.org
  • FHIR API: https://fhir-myrecord.cerner.com/r4/75620b41-1ac4-4c73-abd7-1415dc6810c3/
  • Direct secure messaging: lwiley190045@direct.valleywisehealth.org
  • Direct secure messaging: lwiley.168892@regionalhealth.sdhealthlink.net

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 12

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": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1679056147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7500 N DREAMY DRAW DR STE 145",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850204668",
            "telephone_number": "480-882-4545",
            "fax_number": "480-882-5814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8705 E MCDOWELL RD",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852573909",
            "telephone_number": "480-882-4545",
            "fax_number": "480-946-6997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILEY",
        "first_name": "LARISSA",
        "middle_name": "DOHN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-11",
        "last_updated": "2023-03-14",
        "certification_date": "2022-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "7140",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "7140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "435328",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARISSA",
            "last_name": "DOHN",
            "middle_name": "MARIE",
            "credential": "RDH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Scottsdale, AZ

Sources for this page

Verify at the official NPI Registry.