Physician Assistant - Surgical Assist, LLC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

2841 Issued in AZ

Legal business name

PHYSICIAN ASSISTANT - SURGICAL ASSIST, LLC

Practice address

4980 S Alma School Rd
A2-130
Chandler, AZ 85248-5545

Phone

(480) 215-3035

NPI assigned

Dec 22, 2011

Organization subpart

No

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

Authorized official

Name

Ms. Nicole Vincelette, PANPI 1215955059

Title

Physician Assistant

Phone

(480) 215-3035

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole Elizabeth Vincelette, PA

  • Physician Assistant
  • Chandler, AZ
  • NPI 1215955059
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324512000000",
    "number": "1942579750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4980 S ALMA SCHOOL RD",
            "address_2": "A2-130",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852485545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4980 S ALMA SCHOOL RD",
            "address_2": "A2-130",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852485545",
            "telephone_number": "480-215-3035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN ASSISTANT - SURGICAL ASSIST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-22",
        "last_updated": "2011-12-22",
        "status": "A",
        "authorized_official_last_name": "VINCELETTE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "480-215-3035",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "2841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phoenix Wellbriety Circle LLC
• Tristan Alap Phuong
• Physical Medicine of Arizona, LLC
• Physical Medicine of Chandler LLC
• Physical Rehabilitation and Hand Centers Inc (Chandler Orthopedic & Sports Therapy)
• Physician Management Services of Arizona II, LLC
• Physician Management Services of Arizona, LLC
• Physicians of Arizona PLLC
• Physicians Surgery Center of Chandler, LLC
• Physicians United Surgery Center, LLC

• Surgical Physician Assistant in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Surgical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.