Individual provider Active NPI

James Hennessy, PA-C

  • Physician Assistant
  • Scottsdale, AZ
National Provider Identifier
1801525241
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9186 Issued in AZ
Practice address
8705 E McDowell Rd
Scottsdale, AZ 85257-3909
Phone
(480) 882-4545
Fax
(480) 405-8929
NPI assigned
Jun 9, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X 9186 AZ Primary

Addresses

Primary practice location

8705 E McDowell Rd
Scottsdale, AZ 85257-3909

Mailing address

907 Kemper Dr
Mansfield, TX 76063-3708
Phone (619) 905-6330

Other practice location 1

312 N Alma School Rd Ste 11
Chandler, AZ 85224-4354
Phone (623) 300-5447

Other practice location 2

1030 E Florida Ave
Hemet, CA 92543-4511
Phone (833) 867-4642

Other identifiers 1

IdentifierTypeStateIssuer
163742MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220803003753 NY Practitioner - Physician Assistant 7315329554
I20230111001782 TX Practitioner - Physician Assistant 7315329554 Reassigns benefits to 1 organization

National Provider Directory

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

Organizations & group practices 1

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": "1654732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1801525241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 KEMPER DR",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760633708",
            "telephone_number": "619-905-6330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8705 E MCDOWELL RD",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852573909",
            "telephone_number": "480-882-4545",
            "fax_number": "480-405-8929"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "312 N Alma School Rd Ste 11",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852244354",
            "country_code": "US",
            "telephone_number": "623-300-5447",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1030 E Florida Ave",
            "address_purpose": "LOCATION",
            "city": "Hemet",
            "state": "CA",
            "postal_code": "925434511",
            "country_code": "US",
            "telephone_number": "833-867-4642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENNESSY",
        "first_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-09",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "9186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163742",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsdale, AZ

Sources for this page

Verify at the official NPI Registry.