Active NPI
Kris Thanesjesdapong
- Physician Assistant
- Las Vegas, NV
National Provider Identifier
1760120448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA2828
- Practice address
- 8192 Sorrel St
Las Vegas, NV 89139-6905 - Phone
- (702) 588-3306
- NPI assigned
- May 23, 2022
- 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 | PA2828 | NV | Primary |
Addresses
Primary practice location
8192 Sorrel St
Las Vegas, NV 89139-6905
Mailing address
8192 Sorrel St
Las Vegas, NV 89139-6905
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV, AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
4055 Valley View LN
Suite 700
Dallas, TX 75244-4910
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11162 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Signify Health, LLC | Physician Assistant | Current | Accepting new patients |
Locations
2705 S Alma School Rd
Chandler, AZ 85286
Phone (480) 820-7246
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711497600000",
"number": "1760120448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8192 SORREL ST",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891396905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8192 SORREL ST",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891396905",
"telephone_number": "702-588-3306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THANESJESDAPONG",
"first_name": "KRIS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-05-23",
"last_updated": "2024-03-27",
"certification_date": "2024-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NV",
"license": "PA2828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; 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.