Individual provider Active NPI

Ammon Lambson, PA-C

  • Physician Assistant
  • Gilbert, AZ
National Provider Identifier
1912195041
Registry record updated May 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3722 Issued in AZ
Practice address
2940 E Banner Gateway Dr
Ste 200
Gilbert, AZ 85234-2171
Phone
(480) 964-2908
Fax
(480) 833-2136
NPI assigned
Oct 15, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3722 AZ Primary

Addresses

Primary practice location

2940 E Banner Gateway Dr
Ste 200
Gilbert, AZ 85234-2171

Mailing address

PO Box 29870
Phoenix, AZ 85038-9870
Phone (602) 772-3800

Other identifiers 1

IdentifierTypeStateIssuer
887372MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20161011001498 ID Practitioner - Physician Assistant 2860580123 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1595 Yellowstone Ave
Pocatello, ID 83201-4203
Phone (208) 233-0032

3720 Woodking Dr
Idaho Falls, ID 83404-4720
Phone (208) 227-1100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3722AZMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Orthopaedics Management and Consulting, LLC CurrentSince Aug 30, 2016 Accepting new patients

Locations

3720 Woodking Dr
Idaho Falls, ID 83404
Phone (208) 227-1100

2321 Coronado St
Idaho Falls, ID 83404
Phone (208) 227-1100

1595 Yellowstone Ave
Pocatello, ID 83201
Phone (208) 233-0032

Organizations & group practices 1

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 2

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": "1192406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400198400000",
    "number": "1912195041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29870",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850389870",
            "telephone_number": "602-772-3800",
            "fax_number": "602-772-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 E BANNER GATEWAY DR",
            "address_2": "STE 200",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342171",
            "telephone_number": "480-964-2908",
            "fax_number": "480-833-2136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAMBSON",
        "first_name": "AMMON",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-15",
        "last_updated": "2014-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "3722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "887372",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

Verify at the official NPI Registry.