Anthony Robert Paul, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Peridot, AZ
NPI 1679963169 · NPPES record last updated Mar 28, 2018
Key facts
- NPI
- 1679963169
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- AP7322 (AZ)
- Practice address
- 103 Medicine Way Road
Peridot, AZ 85542 - Phone
- (928) 475-1200
- NPI assigned
- Feb 4, 2015
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- San Carlos Apache Healthcare Corporation
Practice addresses (Care Compare)
103 Medicine Way Rd
Peridot, AZ 85542-0787
Phone (928) 475-1400
P O Box
Suite 787
Peridot, AZ 85542-0787
PO Box
Suite 787
Peridot, AZ 85542-0787
Hospital & facility affiliations
- San Carlos Apache Healthcare Corporation
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160222000258 | TX | Practitioner - Nurse Practitioner | 7012212582 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP7322 | AZ | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Carlos Apache Healthcare Corporation | Current |
Accepting new patients | |
| San Carlos Apache Healthcare Corporation | Current | Accepting new patients |
Locations
103 Medicine Way Rd
Peridot, AZ 85542
Phone (928) 475-1200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP7322 | AZ | Yes |
Addresses
Primary practice location
103 Medicine Way Road
Peridot, AZ 85542
Mailing address
103 Medicine Way Road
Peridot, AZ 85542
Phone (928) 475-1200
Other providers in Peridot, AZ
- Sylvestor A Moses
- Acey Nixon
- Marleah Olsen
- Victor Cecilio Padron
- Anthony T Patterson
- Jared L Rasmussen
- Renal Dimensions, LLC
- San Carlos Apache Healthcare Corporation
- San Carlos Apache Healthcare Corporation
- San Carlos Apache Healthcare Corporation
All providers in Peridot, AZ · Family Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.