Jason Banuelos, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9366 Issued in AZ

Practice address

435 N 5TH St
Phoenix, AZ 85004-2157

Phone

(602) 827-2450

NPI assigned

Jun 3, 2022

Last updated

Dec 12, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Emergency Professional Services PC

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  • NPI 1518984210

  Physician Assistant

  Medicare reassignment NPD
• Emergency Professional Services PC

  • Emergency Medicine Physician
  • Apache Junction, AZ
  • NPI 1205273406

  Physician Assistant

  NPD

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

{
    "created_epoch": "1654214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1699414870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12217 N 129TH DR",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853356270",
            "telephone_number": "623-414-8631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 N 5TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850042157",
            "telephone_number": "602-827-2450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANUELOS",
        "first_name": "JASON",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-03",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "9366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larry Louis Bans, M.D.
• Stephen F Bansberg, M.D.
• Wesley Bantilan, RBT
• Emmanuel Enoch Banto
• Edian Banuelos
• Paige Banyas, DO
• Cesar Joshua Baptiste
• Mohammad Wisam Baqdunes, M.D.
• Bar Physical Therapy LLC
• Stephania Alejandra Barahona Frias, RDH

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.