Jackeline Lucia Sepulveda, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9903 Issued in AZ

Practice address

2946 E Banner Gateway Drive
Gilbert, AZ 85234-2165

Phone

(480) 256-6444

Fax

(480) 256-4734

NPI assigned

Jun 3, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Banner Cancer Center Specialists LLCGroup PAC ID 6103097779, 343 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner Gateway Medical Center Hospital, Gilbert, AZ, CCN 030122
• Banner Thunderbird Medical Center Hospital, Glendale, AZ, CCN 030089

Merit-based Incentive Payment System (MIPS)

Final score

78.42 of 100Reported as group

Quality

62.19

Promoting interoperability

99

Improvement activities

40

Cost

61.29

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Banner Cancer Center Specialists LLC

  • Oncology Clinic/Center
  • Phoenix, AZ
  • NPI 1518253152
  Medicare reassignment Care Compare group
• Banner Cancer Center Specialists LLC

  • Oncology Clinic/Center
  • Payson, AZ
  • NPI 1588158448
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Banner Gateway Medical Center

  • General Acute Care Hospital
  • Gilbert, AZ
  • NPI 1699884858
  Care Compare affiliation
• Banner Thunderbird Medical Center

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1154355188
  Care Compare affiliation

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

{
    "created_epoch": "1654214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739491200000",
    "number": "1790424968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 E BANNER GATEWAY DRIVE",
            "address_2": "SUITE 450",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342165",
            "telephone_number": "480-256-6444",
            "fax_number": "480-256-4734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2946 E BANNER GATEWAY DRIVE",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342165",
            "telephone_number": "480-256-6444",
            "fax_number": "480-256-4734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEPULVEDA",
        "first_name": "JACKELINE",
        "middle_name": "LUCIA",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-03",
        "last_updated": "2025-02-14",
        "certification_date": "2023-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "9903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Selva
• Caitlin Sembach, DC
• Whitney Semmens
• Arianna Vatsanna Senlouangrat, RBT, BCAT
• Rylee Michelle Sepiol
• Natalie G Sepulveda, PA-C
• Serendipity Lifestyles LLC
• Serenity Dental
• Serenity Dental Offices LLC (Serenity Dental)
• Serenity Residential Homes, LLC

• Physician Assistant in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2025; 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.

Verify at the official NPI Registry.