Individual provider Active NPI

Clarrissa Gober, NP

  • Nurse Practitioner
  • Avondale, AZ
National Provider Identifier
1881015162
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP8458 Issued in AZ
Practice address
10815 W McDowell Rd Ste 201
Avondale, AZ 85392-5010
Phone
(623) 433-0230
Fax
(623) 433-0211
NPI assigned
Jan 3, 2014
Last updated
Aug 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP8458 AZ Primary

Addresses

Primary practice location

10815 W McDowell Rd Ste 201
Avondale, AZ 85392-5010

Mailing address

3815 E Bell Rd Ste 4500
Phoenix, AZ 85032-2171
Phone (602) 633-3838

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160321001733 AZ Practitioner - Nurse Practitioner 0345471884 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

10815 W McDowell Rd
Suite 205
Avondale, AZ 85392-5010
Phone (623) 433-0202

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group Arizona, LLC CurrentSince Sep 20, 2021 Accepting new patients
Privia Medical Group Arizona, LLC CurrentSince Sep 20, 2021 Accepting new patients
Privia Medical Group Arizona, LLC Past Accepting new patients

Locations

10815 W McDowell Rd
Ste 201
Avondale, AZ 85392
Phone (623) 433-0230

10815 W McDowell Rd
Ste 202
Avondale, AZ 85392

10815 W McDowell Rd
Ste 205
Avondale, AZ 85392
Phone (623) 848-3295

14415 W McDowell Rd
Ste D102
Goodyear, AZ 85395
Phone (623) 512-4190

1301 S 7th Ave
Ste 400
Phoenix, AZ 85007
Phone (602) 824-3358

3815 E Bell Rd
Ste 2200
Phoenix, AZ 85032
Phone (602) 931-4689

3815 E Bell Rd
Ste 4500
Phoenix, AZ 85032
Phone (602) 633-3838

Interoperability endpoints

  • Direct secure messaging: clarrissa.gober.2@33227.direct.athenahealth.com

Organizations & group practices 3

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": "1388707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1881015162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 E BELL RD STE 4500",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322171",
            "telephone_number": "602-633-3838",
            "fax_number": "602-633-3841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10815 W MCDOWELL RD STE 201",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853925010",
            "telephone_number": "623-433-0230",
            "fax_number": "623-433-0211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOBER",
        "first_name": "CLARRISSA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-03",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "AP8458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avondale, AZ

Sources for this page

Verify at the official NPI Registry.