Individual provider Active NPI

Jared Michael Susini, PA-C

  • Physician Assistant
  • Gilbert, AZ
National Provider Identifier
1740513019
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4476 Issued in AZ
Practice address
2940 E Banner Gateway Dr
Ste 200
Gilbert, AZ 85234-2168
Phone
(480) 964-2908
Fax
(480) 833-2136
NPI assigned
Sep 17, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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 4476 AZ
Physician Assistant 363A00000X 4476 AZ Primary

Addresses

Primary practice location

2940 E Banner Gateway Dr
Ste 200
Gilbert, AZ 85234-2168

Mailing address

PO Box 80217
Phoenix, AZ 85060-0217
Phone (602) 385-2115

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
I20091016000021 AZ Practitioner - Physician Assistant 6103963590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic Specialists of North America PLLCGroup PAC ID 7719014505, 310 clinicians

Practice addresses (Care Compare)

2940 E Banner Gateway Dr
Gilbert, AZ 85234-2168

5620 E Bell Rd
Scottsdale, AZ 85254-5950
Phone (602) 385-2115

Hospital & facility affiliations

  • Arizona Spine and Joint Hospital Hospital, Mesa, AZ, CCN 030107

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4476AZMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Specialists of North America, PLLC CurrentSince Jul 14, 2014 Accepting new patients
Arizona Spine and Joint Hospital LLC Current Accepting new patients
Orthopedic Specialists of North America, PLLC CurrentSince Jul 14, 2014 Accepting new patients
Center for Physical Medicine & Rehabilitation P C Past Accepting new patients
District Medical Group, Inc Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
Orthopedic Specialists of North America, PLLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
Med 97 LLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
Gold Star Medical LLC Past Accepting new patients

Locations

525 S Chandler Village Dr
Chandler, AZ 85226
Phone (480) 750-0303

1760 E Pecos Rd
Ste 207
Gilbert, AZ 85295
Phone (480) 813-0944

2940 E Banner Gateway Dr
Ste 200250
Gilbert, AZ 85234

2940 E Banner Gateway Dr
Ste 200
Gilbert, AZ 85234

14044 W Camelback Rd
Ste 120
Litchfield Park, AZ 85340
Phone (623) 846-7614

6620 E McKellips Rd
Ste 105
Mesa, AZ 85215
Phone (602) 922-9090

2355 E Camelback Rd
Ste 325
Phoenix, AZ 85016
Phone (602) 772-3795

5620 E Bell Rd
Scottsdale, AZ 85254
Phone (602) 485-3050

Interoperability endpoints

  • Direct secure messaging: jaredsusini@asjh.medalliesdirect.net

Organizations & group practices 13

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.

View all 13

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": "1253145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1740513019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80217",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850600217",
            "telephone_number": "602-385-2115",
            "fax_number": "480-418-3323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 E BANNER GATEWAY DR",
            "address_2": "STE 200",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342168",
            "telephone_number": "480-964-2908",
            "fax_number": "480-833-2136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSINI",
        "first_name": "JARED",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-17",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "4476",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "4476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

Verify at the official NPI Registry.