NPIMap

Individual provider Active NPI

Debbie Sunshine Mascovich, PAC

  • Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1912983008
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5137 Issued in AZ
Practice address
5201 N 19TH Ave Ste 121
Phoenix, AZ 85015-2901
Phone
(602) 433-1822
Fax
(602) 246-7060
NPI assigned
Dec 20, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 763 CO
Physician Assistant 363A00000X 5137 AZ Primary

Addresses

Primary practice location

5201 N 19TH Ave Ste 121
Phoenix, AZ 85015-2901

Mailing address

PO Box 47328
Phoenix, AZ 85068-7328
Phone (970) 778-1432

Other identifiers 1

IdentifierTypeStateIssuer
03457036MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
763COMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Group, LLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
19TH Avenue Clinic LLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
Honorhealth Urgent Care, LLC Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354060800000",
    "number": "1912983008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 47328",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850687328",
            "telephone_number": "970-778-1432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 N 19TH AVE STE 121",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850152901",
            "telephone_number": "602-433-1822",
            "fax_number": "602-246-7060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASCOVICH",
        "first_name": "DEBBIE",
        "middle_name": "SUNSHINE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-20",
        "last_updated": "2012-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "763",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03457036",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.