Clarence Jason Vastine, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP3558 Issued in AZ

Practice address

13555 W McDowell Rd Ste 103
Goodyear, AZ 85395-2625

Phone

(623) 932-1157

Fax

(623) 935-1045

NPI assigned

Mar 29, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

Nurse Practitioner

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Privia Medical Group Arizona, LLCGroup PAC ID 1052328408, 94 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Meridian Healthcare Providers, Inc. Home health agency, Phoenix, AZ, CCN 037250

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: clarence.vastine.2@33227.direct.athenahealth.com

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.

• Privia Medical Group Arizona, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1760441141
  Medicare reassignment Care Compare group NPD
• Privia Medical Group Arizona, LLC

  • Neurology Physician
  • Phoenix, AZ
  • NPI 1245876705
  NPD
• Privia Medical Group Arizona, LLC

  • Family Medicine Physician
  • Payson, AZ
  • NPI 1740459700
  NPD

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

• Meridian Health Care Providers, Inc

  • Home Health Agency
  • Phoenix, AZ
  • NPI 1982798823
  Care Compare affiliation

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

{
    "created_epoch": "1269820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1902121379",
    "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": "602-633-3848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13555 W MCDOWELL RD STE 103",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952625",
            "telephone_number": "623-932-1157",
            "fax_number": "623-935-1045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASTINE",
        "first_name": "CLARENCE",
        "middle_name": "JASON",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-29",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP3558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "510044",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z136913",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vanderbilt Farms Assisted Living LLC
• Kari Suzanne Vanderhei, P.T.
• Zekiel Vandernaalt, PT, DPT
• Anna Vargas-Leveriza, PHD, LPC, LASAC
• Regina Lynn Vargas, PHARMACY TECHICIAN
• Shannon Vaughan, MS, OTR/L
• Donna Marie Vaughn
• Yanire Fabiola Vega, DMD
• Mary E Vejnoska, APRN, FNP
• David Velasquez

• Family Nurse Practitioner in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.