NPIMap

Individual provider Active NPI

Cassandra Ann Nebosky-Diaz, PA

  • Physician Assistant
  • Fayetteville, NC
National Provider Identifier
1790259430
Registry record updated Jan 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-08461 Issued in NC
Practice address
659 Daharan Dr
Fayetteville, NC 28314-6538
Phone
(336) 210-5920
NPI assigned
Jan 16, 2019
Last updated
Jan 16, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 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 0010-08461 NC Primary

Addresses

Primary practice location

659 Daharan Dr
Fayetteville, NC 28314-6538

Mailing address

659 Daharan Dr
Fayetteville, NC 28314-6538
Phone (336) 210-5920

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190308002232 NC Practitioner - Physician Assistant 4486993458 Reassigns benefits to 6 organizations
I20250801000898 TN Practitioner - Physician Assistant 4486993458 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
89.09 of 100Reported as group
Quality
84.49
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
86.5 of 100Reported as group
Quality
84.11
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
92.02 of 100Reported as group
Quality
82.48
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6533TNMDOccupational Therapist

Interoperability endpoints

  • Direct secure messaging: cneboskydiaz846170@direct.unc.nchie.net

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547596800000",
    "number": "1790259430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "659 DAHARAN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283146538",
            "telephone_number": "336-210-5920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "659 DAHARAN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283146538",
            "telephone_number": "336-210-5920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEBOSKY-DIAZ",
        "first_name": "CASSANDRA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-16",
        "last_updated": "2019-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-08461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.