Individual provider Active NPI

Phillip Allen Schafer, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Prescott, AZ
National Provider Identifier
1790276608
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP11322 Issued in AZ
Practice address
212 S Montezuma St Ste 3
Prescott, AZ 86303-4720
Phone
(928) 277-0001
Fax
(928) 350-6228
NPI assigned
May 25, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X AP11322 AZ Primary
Family Nurse Practitioner 363LF0000X AP11311 AZ

Addresses

Primary practice location

212 S Montezuma St Ste 3
Prescott, AZ 86303-4720

Mailing address

212 S Montezuma St Ste 3
Prescott, AZ 86303-4720
Phone (928) 277-0001

Other identifiers 1

IdentifierTypeStateIssuer
1437992112OtherAZGRANITE MOUNTAIN LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP11311AZMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1527206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1790276608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 S MONTEZUMA ST STE 3",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863034720",
            "telephone_number": "928-277-0001",
            "fax_number": "928-350-6228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 S MONTEZUMA ST STE 3",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863034720",
            "telephone_number": "928-277-0001",
            "fax_number": "928-350-6228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHAFER",
        "first_name": "PHILLIP",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-25",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "AP11322",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP11311",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GRANITE MOUNTAIN LLC",
            "identifier": "1437992112",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2025; 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.