Individual provider Active NPI

Kylie Lasota

  • Physician Assistant
  • Goodyear, AZ
National Provider Identifier
1689415184
Registry record updated Mar 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11418 Issued in AZ
Practice address
13677 W McDowell Rd
Goodyear, AZ 85395-2635
Phone
(623) 882-1500
NPI assigned
Jun 6, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 11418 AZ Primary

Addresses

Primary practice location

13677 W McDowell Rd
Goodyear, AZ 85395-2635

Mailing address

13677 W McDowell Rd
Goodyear, AZ 85395-2635

Other practice location 1

2000 W Bethany Home Rd
Phoenix, AZ 85015-2443
Phone (602) 249-0212

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
I20260202003475 AZ Practitioner - Physician Assistant 8628556495 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Group of Arizona Professional CorporationGroup PAC ID 1355596644, 102 clinicians

Practice addresses (Care Compare)

2000 W Bethany Home Rd
Phoenix, AZ 85015-2110
Phone (602) 249-0212

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11418AZMDOccupational Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Group of Arizona Professional Corporation Physician Assistant CurrentSince Feb 1, 2026 Accepting new patients

Locations

13677 W McDowell Rd
Goodyear, AZ 85395
Phone (623) 536-4200

1930 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 532-1000

2000 W Bethany Home Rd
Phoenix, AZ 85015
Phone (480) 209-4000

Organizations & group practices 1

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": "1717632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772496000000",
    "number": "1689415184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13677 W MCDOWELL RD",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13677 W MCDOWELL RD",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952635",
            "telephone_number": "623-882-1500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 W Bethany Home Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850152443",
            "country_code": "US",
            "telephone_number": "602-249-0212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LASOTA",
        "first_name": "KYLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-06",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "11418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

Verify at the official NPI Registry.