JDL-Ctspa

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

3608 Issued in AZ

Legal business name

JDL-CTSPA

Practice address

4521 W Hopi TRL
Laveen, AZ 85339-2068

Phone

(602) 795-3371

NPI assigned

Jul 14, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Jeanine Diane Lutgen, PA-C

Title

Manager

Phone

(602) 795-3371

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tara Marie Lindsey, PA-C

  • Physician Assistant
  • Scottsdale, AZ
  • NPI 1710139894
  NPD (past)

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

{
    "created_epoch": "1215993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554681600000",
    "number": "1831353382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 436",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853390436",
            "telephone_number": "027-953-3716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4521 W HOPI TRL",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853392068",
            "telephone_number": "602-795-3371"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5446 W Samantha Way",
            "address_purpose": "LOCATION",
            "city": "Laveen",
            "state": "AZ",
            "postal_code": "853397160",
            "country_code": "US",
            "telephone_number": "602-795-3371",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1930 E Thomas Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850167711",
            "country_code": "US",
            "telephone_number": "602-532-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18701 N 67th Ave",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853087100",
            "country_code": "US",
            "telephone_number": "623-561-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10401 W Thunderbird Blvd",
            "address_purpose": "LOCATION",
            "city": "Sun City",
            "state": "AZ",
            "postal_code": "853513004",
            "country_code": "US",
            "telephone_number": "623-977-7211",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13677 W McDowell Rd",
            "address_purpose": "LOCATION",
            "city": "Goodyear",
            "state": "AZ",
            "postal_code": "853952635",
            "country_code": "US",
            "telephone_number": "623-882-1500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1400 S Dobson Rd",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852024707",
            "country_code": "US",
            "telephone_number": "489-512-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9201 W Thomas Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850373332",
            "country_code": "US",
            "telephone_number": "623-327-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5555 W Thunderbird Rd",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853064622",
            "country_code": "US",
            "telephone_number": "602-865-5555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6750 E Baywood Ave",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852061749",
            "country_code": "US",
            "telephone_number": "480-854-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1955 W Frye Rd",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852246282",
            "country_code": "US",
            "telephone_number": "480-728-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JDL-CTSPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-14",
        "last_updated": "2019-04-08",
        "status": "A",
        "authorized_official_last_name": "LUTGEN",
        "authorized_official_first_name": "JEANINE",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "602-795-3371",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "3608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z123651",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Laveen, AZ
• Providers in Laveen, AZ by specialty
• Surgical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2019; 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.