Individual provider Active NPI

Jeffrey Paullus, PA

  • Physician Assistant
  • Apache Junction, AZ
National Provider Identifier
1700214673
Registry record updated Oct 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA23242 Issued in CA
Practice address
1016 E Greenlee Ave
Apache Junction, AZ 85119-7238
Phone
(909) 435-6531
NPI assigned
Oct 31, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 31, 2013

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 PA23242 CA Primary

Addresses

Primary practice location

1016 E Greenlee Ave
Apache Junction, AZ 85119-7238

Mailing address

1016 E Greenlee Ave
Apache Junction, AZ 85119-7238
Phone (909) 435-6531

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20131206001417 CA Practitioner - Physician Assistant 6507093093 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the University of Claifornia Univ NeursciencesGroup PAC ID 2769476357, 72 clinicians

Practice addresses (Care Compare)

101 The City Dr S
Orange, CA 92868-3201
Phone (714) 456-7004

Hospital & facility affiliations

  • Uci Health-Orange Hospital, Orange, CA, CCN 050348

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA23242CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of California Irvine Past Accepting new patients
University of California Irvine Past Accepting new patients

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1383177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383177600000",
    "number": "1700214673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 E GREENLEE AVE",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "851197238",
            "telephone_number": "909-435-6531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 E GREENLEE AVE",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "851197238",
            "telephone_number": "909-435-6531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULLUS",
        "first_name": "JEFFREY",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-10-31",
        "last_updated": "2013-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA23242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apache Junction, AZ

Sources for this page

Verify at the official NPI Registry.