Individual provider Active NPI

Marisa Raquel Fernandez, MD

  • Psychiatry Physician
  • Tucson, AZ
National Provider Identifier
1922598648
Registry record updated Jun 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
R76788 Issued in AZ
Practice address
2800 E Ajo Way
Tucson, AZ 85713-6204
Phone
(520) 874-2000
NPI assigned
May 17, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X R76788 AZ Primary

Addresses

Primary practice location

2800 E Ajo Way
Tucson, AZ 85713-6204

Mailing address

110 S Church Ave Unit 548
Tucson, AZ 85701-1657
Phone (602) 740-7470

Other practice location 1

1501 N Campbell Ave
Tucson, AZ 85724-0001
Phone (520) 694-0111

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
I20220706000540 AZ Practitioner - Psychiatry 1658622162 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Arizona College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Banner-University Medical GroupGroup PAC ID 7719899871, 1,066 clinicians

Practice addresses (Care Compare)

2800 E Ajo Way
Tucson, AZ 85713-6204
Phone (520) 874-2000

Hospital & facility affiliations

  • Banner-University Medical Center South Campus Hospital, Tucson, AZ, CCN 030111

Merit-based Incentive Payment System (MIPS)

Final score
93.34 of 100Reported as apm
Quality
74.56
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner-University Medical Group CurrentSince Aug 8, 2022 Accepting new patients
Banner-University Medical Group Family Medicine CurrentSince Aug 8, 2022 Accepting new patients
Banner - University Medical Center South Campus LLC Past Accepting new patients

Locations

535 N Wilmot Rd
Ste 101
Tucson, AZ 85711
Phone (520) 694-9988

1501 N Campbell Ave
Tucson, AZ 85724
Phone (520) 626-7747

1625 N Campbell Ave
Tucson, AZ 85719

2800 E Ajo Way
Tucson, AZ 85713
Phone (520) 294-4471

Organizations & group practices 3

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": "1526515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1922598648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S CHURCH AVE UNIT 548",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857011657",
            "telephone_number": "602-740-7470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 E AJO WAY",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857136204",
            "telephone_number": "520-874-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 N Campbell Ave",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857240001",
            "country_code": "US",
            "telephone_number": "520-694-0111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "MARISA",
        "middle_name": "RAQUEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-17",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AZ",
            "license": "R76788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.