Individual provider Active NPI

Milan T Trisic, PA

  • Physician Assistant
  • Gilbert, AZ
National Provider Identifier
1679345003
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10138 Issued in AZ
Practice address
2946 E Banner Gateway Dr
Gilbert, AZ 85234
Phone
(480) 256-6444
Fax
(480) 256-3682
NPI assigned
Oct 30, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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 10138 AZ
Physician Assistant 363A00000X 10138 AZ Primary

Addresses

Primary practice location

2946 E Banner Gateway Dr
Gilbert, AZ 85234

Mailing address

2946 E Banner Gateway Dr
Gilbert, AZ 85234
Phone (480) 256-6444

Other practice location 1

13400 E Shea Blvd
Scottsdale, AZ 85259-5499
Phone (480) 301-8000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mtrisic2283636@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20231218001553 AZ Practitioner - Physician Assistant 6507215449 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Arizona CurrentSince Sep 30, 2024 Accepting new patients
Mayo Clinic Arizona CurrentSince Sep 30, 2024 Accepting new patients
Banner Cancer Center Specialists LLC CurrentSince Jan 22, 2024 Accepting new patients

Locations

1900 N Higley Rd
Gilbert, AZ 85234
Phone (480) 543-2000

2946 E Banner Gateway Dr
Rm 2008
Gilbert, AZ 85234
Phone (480) 256-4523

2946 E Banner Gateway Dr
Gilbert, AZ 85234
Phone (480) 256-5450

5777 E Mayo Blvd
Phoenix, AZ 85054
Phone (480) 342-1800

13400 E Shea Blvd
Scottsdale, AZ 85259

Organizations & group practices 4

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": "1698624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1679345003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2946 E BANNER GATEWAY DR",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85234",
            "telephone_number": "480-256-6444",
            "fax_number": "480-256-3682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2946 E BANNER GATEWAY DR",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85234",
            "telephone_number": "480-256-6444",
            "fax_number": "480-256-3682"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13400 E Shea Blvd",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852595499",
            "country_code": "US",
            "telephone_number": "480-301-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRISIC",
        "first_name": "MILAN",
        "middle_name": "T",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-30",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "10138",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "10138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mtrisic2283636@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "13400 E Shea Blvd",
            "city": "Scottsdale",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852595499",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

Verify at the official NPI Registry.