Individual provider Active NPI

Jennifer Preston, MD

  • Surgery Physician
  • Phoenix, AZ
National Provider Identifier
1902066111
Registry record updated Sep 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
49099 Issued in AZ
Practice address
1300 N 12TH St
512
Phoenix, AZ 85006-2848
Phone
(602) 258-1519
Fax
(602) 258-5845
NPI assigned
Jun 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Surgery Physician 208600000X MD162105 OR
Surgery Physician 208600000X 49099 AZ Primary

Addresses

Primary practice location

1300 N 12TH St
512
Phoenix, AZ 85006-2848

Mailing address

1300 N 12TH St
512
Phoenix, AZ 85006-2848
Phone (602) 258-1519

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140709002205 AZ Practitioner - General Surgery 0446496525 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Arizona College of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1111 E McDowell Rd
Phoenix, AZ 85006-2612
Phone (602) 839-2000

1300 N 12TH St
Suite 508
Phoenix, AZ 85006-2849
Phone (602) 839-3927

1400 S Dobson Rd
Mesa, AZ 85202-4707
Phone (480) 412-3000

1441 N 12TH St
Phoenix, AZ 85006-2837
Phone (844) 242-4664

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.85 of 100Reported as group
Quality
69.75
Promoting interoperability
98
Improvement activities
40
Cost
68.18

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
49099AZMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner - University Hospital Based Physicians LLC CurrentSince Sep 14, 2023 Accepting new patients
Banner - University Hospital Based Physicians LLC CurrentSince Sep 14, 2023 Accepting new patients
Banner - University Physician Specialists LLC CurrentSince May 1, 2016 Accepting new patients
Banner - University Physician Specialists LLC CurrentSince May 1, 2016 Accepting new patients

Locations

1441 N 12th St
Ste 3
Phoenix, AZ 85006

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

1441 N 12th St
Fl 2AND3
Phoenix, AZ 85006

1300 N 12th St
Ste 512
Phoenix, AZ 85006
Phone (602) 258-1519

4200 E Camelback Rd
Ste 202
Phoenix, AZ 85018
Phone (602) 229-2150

1441 N 12th St
Fl 2
Phoenix, AZ 85006
Phone (602) 521-5180

1300 N 12th St
Ste 508
Phoenix, AZ 85006
Phone (602) 839-3927

1441 N 12th St
Fl 3
Phoenix, AZ 85006
Phone (602) 521-5700

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1213142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473724800000",
    "number": "1902066111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N 12TH ST",
            "address_2": "512",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062848",
            "telephone_number": "602-258-1519",
            "fax_number": "602-258-5845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N 12TH ST",
            "address_2": "512",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062848",
            "telephone_number": "602-258-1519",
            "fax_number": "602-258-5845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESTON",
        "first_name": "JENNIFER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-11",
        "last_updated": "2016-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD162105",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "49099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.