Individual provider Active NPI

Jeremy D. Platt, P.A.-C

  • Surgical Physician Assistant
  • Prescott, AZ
National Provider Identifier
1720028095
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
3348 Issued in AZ
Practice address
1001 Willow Creek Rd Ste 3300
Prescott, AZ 86301-1614
Phone
(928) 458-2996
Fax
(928) 458-2135
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 3348 AZ Primary
Medical Physician Assistant 363AM0700X 3348 AZ

Addresses

Primary practice location

1001 Willow Creek Rd Ste 3300
Prescott, AZ 86301-1614

Mailing address

PO Box 10880
Prescott, AZ 86304-0880
Phone (602) 406-4786

Other practice location 1

1001 Willow Creek Rd Ste 3100
Prescott, AZ 86301-1614
Phone (928) 445-4818

Other identifiers 1

IdentifierTypeStateIssuer
629253MedicaidAZ

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
I20061116000230 AZ Practitioner - Physician Assistant 9032117502 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yavapai Regional Medical Center Physician Care LLCGroup PAC ID 5294898987, 123 clinicians

Practice addresses (Care Compare)

1001 Willow Creek Rd
Prescott, AZ 86301-1614

1003 Willow Creek Rd
Prescott, AZ 86301-1641

3120 Clearwater Dr
Prescott, AZ 86305-7131
Phone (928) 771-3704

Hospital & facility affiliations

  • Yavapai Regional Medical Center Hospital, Prescott, AZ, CCN 030012

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3348AZMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Sep 1, 2011 Accepting new patients
Prescott Gastroenterology Past Accepting new patients
Desert Neurosurgery, PC Past Accepting new patients

Locations

1001 Willow Creek Rd
Ste 3300
Prescott, AZ 86301
Phone (928) 458-2996

3120 Clearwater Dr
Prescott, AZ 86305
Phone (928) 445-4818

1001 Division St
Prescott, AZ 86301
Phone (928) 445-4818

1001 Willow Creek Rd
Ste 3100
Prescott, AZ 86301
Phone (928) 445-4818

Interoperability endpoints

  • Direct secure messaging: jeremy.d.platt@direct.yrmc.org

Organizations & group practices 4

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 1

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1720028095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 WILLOW CREEK RD STE 3300",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011614",
            "telephone_number": "928-458-2996",
            "fax_number": "928-458-2135"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 Willow Creek Rd Ste 3100",
            "address_purpose": "LOCATION",
            "city": "Prescott",
            "state": "AZ",
            "postal_code": "863011614",
            "country_code": "US",
            "telephone_number": "928-445-4818",
            "fax_number": "928-445-4837",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PLATT",
        "first_name": "JEREMY",
        "middle_name": "D.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "3348",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "3348",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "629253",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.