Provider Provider PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

PROVIDER PROVIDER PC

Practice address

841 W 11TH St
Mesa, AZ 85201-3109

Phone

(480) 461-9822

NPI assigned

Jul 28, 2018

Last updated

Dec 20, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jonathan Harris, PHYSICIAN ASSISTANT

Title

PA-C/Member of Corporation

Phone

(480) 461-9822

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545264000000",
    "number": "1760969190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 W 11TH ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852013109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 W 11TH ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852013109",
            "telephone_number": "480-461-9822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDER PROVIDER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-28",
        "last_updated": "2018-12-20",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PA-C/MEMBER OF CORPORATION",
        "authorized_official_telephone_number": "480-461-9822",
        "authorized_official_credential": "PHYSICIAN ASSISTANT"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.