NPIMap

Individual provider Active NPI

Theresa Ann Denison, PA

  • Medical Physician Assistant
  • Mesa, AZ
National Provider Identifier
1891136164
Registry record updated Jul 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5417 Issued in AZ
Practice address
334 W 10TH PL
Ste 100
Mesa, AZ 85201-3497
Phone
(480) 834-0771
Fax
(480) 834-1136
NPI assigned
Jul 15, 2013
Last updated
Jul 15, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5417 AZ Primary

Addresses

Primary practice location

334 W 10TH PL
Ste 100
Mesa, AZ 85201-3497

Mailing address

334 W 10TH PL
Ste 100
Mesa, AZ 85201-3497
Phone (480) 834-0771

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150114000803 CO Practitioner - Physician Assistant 6002040730 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

Broomfield, CO 80021
Phone (720) 807-4461

12790 W Alameda Pkwy a
Green Mountain Clinic Primary Care
Lakewood, CO 80228-2850
Phone (303) 403-6350

8350 Colorado Blvd
Unit 160
Firestone, CO 80504-6803
Phone (303) 673-1370

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5417AZMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Denver, LLC CurrentSince Jan 1, 2015 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Jan 1, 2015 Accepting new patients
Intermountain Front Range, Inc. CurrentSince Nov 17, 2014 Accepting new patients
Intermountain Front Range, Inc. CurrentSince Nov 17, 2014 Accepting new patients
Intermountain Medical Group Denver, LLC Past Accepting new patients
Central Arizona Gastroenterology PC PastSince Mar 30, 2025 Accepting new patients

Locations

12790 W Alameda Pkwy
Ste A
Lakewood, CO 80228
Phone (303) 403-6350

500 Discovery Pkwy
Ste 100
Superior, CO 80027
Phone (303) 403-7800

3210 Lutheran Pkwy
Wheat Ridge, CO 80033
Phone (303) 425-8000

Organizations & group practices 7

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1373846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373846400000",
    "number": "1891136164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "334 W 10TH PL",
            "address_2": "STE 100",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852013497",
            "telephone_number": "480-834-0771",
            "fax_number": "480-834-1136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "334 W 10TH PL",
            "address_2": "STE 100",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852013497",
            "telephone_number": "480-834-0771",
            "fax_number": "480-834-1136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENISON",
        "first_name": "THERESA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-15",
        "last_updated": "2013-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "5417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.