Individual provider Active NPI

Jonathan Delossantos, P.A.

  • Physician Assistant
  • Mesa, AZ
National Provider Identifier
1780080549
Registry record updated Jun 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5881 Issued in AZ
Practice address
2152 S Vineyard Ste 131
Mesa, AZ 85210
Phone
(480) 788-8539
Fax
(844) 538-9355
NPI assigned
Nov 6, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5881 AZ Primary

Addresses

Primary practice location

2152 S Vineyard Ste 131
Mesa, AZ 85210

Mailing address

2152 S Vineyard Ste 131
Mesa, AZ 85210-6882
Phone (480) 788-8539

Other practice location 1

7425 E Shea Blvd
Suite 100
Scottsdale, AZ 85260-6411
Phone (480) 285-2180

Other practice location 2

7261 S Broadway Ste 10L
Littleton, CO 80122-8017
Phone (855) 538-9355 ext. 410

Other practice location 3

7425 E Shea Blvd
Suite 100
Scottsdale, AZ 85260-6411
Phone (480) 285-2180

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
I20160105000529 AZ Practitioner - Physician Assistant 7315249679 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5881AZMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Susan del Sordi Staats, DO PLLC PastSince Mar 21, 2018 Accepting new patients
Flow Rheumatology, PLLC PastSince Jun 1, 2020 Accepting new patients

Organizations & group practices 3

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": "1415232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1780080549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2152 S VINEYARD STE 131",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106882",
            "telephone_number": "480-788-8539",
            "fax_number": "844-538-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2152 S VINEYARD STE 131",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85210",
            "telephone_number": "480-788-8539",
            "fax_number": "844-538-9355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7425 E Shea Blvd",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852606411",
            "country_code": "US",
            "telephone_number": "480-285-2180",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7261 S Broadway Ste 10L",
            "address_purpose": "LOCATION",
            "city": "Littleton",
            "state": "CO",
            "postal_code": "801228017",
            "country_code": "US",
            "telephone_number": "855-538-9355 x410",
            "fax_number": "844-538-9355",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7425 E Shea Blvd",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852606411",
            "country_code": "US",
            "telephone_number": "480-285-2180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DELOSSANTOS",
        "first_name": "JONATHAN",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-11-06",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.