Active NPI
Trenten James Dippold, PA
- Physician Assistant
- Phoenix, AZ
National Provider Identifier
1700618790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10657
- Practice address
- 1300 N 12TH St Ste 500
Phoenix, AZ 85006-2849 - Phone
- (602) 839-4567
- NPI assigned
- Aug 17, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10657 | AZ | Primary |
Addresses
Primary practice location
1300 N 12TH St Ste 500
Phoenix, AZ 85006-2849
Mailing address
555 N College Ave Apt 4047
Tempe, AZ 85288-0222
Phone (814) 706-5074
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1300 N 12TH St
Phoenix, AZ 85006-2849
Hospital & facility affiliations
- Banner - University Medical Center Phoenix
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10657 | AZ | MD | Emergency Medicine Physician |
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.
-
- Primary Care Clinic/Center
- Payson, AZ
- NPI 1154791960
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Phoenix, AZ
- NPI 1841224870
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736294400000",
"number": "1700618790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 N COLLEGE AVE APT 4047",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852880222",
"telephone_number": "814-706-5074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 N 12TH ST STE 500",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062849",
"telephone_number": "602-839-4567"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIPPOLD",
"first_name": "TRENTEN",
"middle_name": "JAMES",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-08-17",
"last_updated": "2025-01-08",
"certification_date": "2025-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "10657",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.