Individual provider Active NPI

Laura Marie Paulson, PA-C

  • Medical Physician Assistant
  • Globe, AZ
National Provider Identifier
1972053072
Registry record updated Jul 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
6466 Issued in AZ
Practice address
1100 N Broad St
Suite B
Globe, AZ 85501-2757
Phone
(928) 425-8200
Fax
(928) 425-8406
NPI assigned
Oct 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 6466 AZ Primary

Addresses

Primary practice location

1100 N Broad St
Suite B
Globe, AZ 85501-2757

Mailing address

4088 E Jasper Dr
Gilbert, AZ 85296-8460
Phone (928) 425-8200

Other names 1

  • Laura Marie Tennant Former name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170112001240 AZ Practitioner - Physician Assistant 2365724069 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Banner Urgent Care Services LLCGroup PAC ID 4284921610, 207 clinicians
Banner Urgent Care Arizona LLCGroup PAC ID 3678749496, 47 clinicians

Practice addresses (Care Compare)

10330 N Scottsdale Rd
Suite 25
Scottsdale, AZ 85253-1427
Phone (602) 255-7625

1215 S Higley Rd
Mesa, AZ 85206-3486
Phone (480) 827-5740

1660 N Higley Rd
Suite 104
Gilbert, AZ 85234-1615
Phone (480) 827-5600

1676 E McMurray Blvd
Suite 1
Casa Grande, AZ 85122-4798
Phone (520) 316-0688

1908 E McKellips Rd
Mesa, AZ 85203-2866
Phone (480) 827-5610

1955 W Guadalupe Rd
Suite 101 102
Mesa, AZ 85202-7487
Phone (480) 827-5620

2950 S Alma School Rd
Suite 1
Chandler, AZ 85286-8120
Phone (480) 827-5690

35945 N Gary Rd
San Tan Valley, AZ 85143-5748
Phone (480) 827-5750

40773 N Ironwood Dr
San Tan Valley, AZ 85140-7002
Phone (480) 827-5760

641 W Warner Rd
Gilbert, AZ 85233-7266
Phone (480) 827-5680

931 E Elliot Rd
Suite 115
Tempe, AZ 85284-1583
Phone (480) 827-5640

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6466AZMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Urgent Care Arizona LLC CurrentSince Feb 1, 2018 Accepting new patients
Banner Urgent Care Services, LLC Current Accepting new patients
Banner Urgent Care Services, LLC CurrentSince Mar 6, 2018 Accepting new patients

Locations

1676 E McMurray Blvd
Ste 1
Casa Grande, AZ 85122
Phone (520) 316-0688

1121 S Gilbert Rd
Ste 101
Mesa, AZ 85204
Phone (480) 644-9355

1215 S Higley Rd
Mesa, AZ 85206
Phone (480) 218-4022

3141 E Indian School Rd
Ste 102
Phoenix, AZ 85016
Phone (602) 255-7700

1 N Central Ave
Ste 105
Phoenix, AZ 85004
Phone (602) 225-7650

35945 N Gary Rd
San Tan Valley, AZ 85143
Phone (480) 827-5750

10330 N Scottsdale Rd
Ste 25
Scottsdale, AZ 85253
Phone (602) 255-7625

7066 E Golf Links Rd
Tucson, AZ 85730
Phone (520) 514-0344

Organizations & group practices 6

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": "1476230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563408000000",
    "number": "1972053072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4088 E JASPER DR",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852968460",
            "telephone_number": "928-425-8200",
            "fax_number": "928-425-8406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N BROAD ST",
            "address_2": "SUITE B",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855012757",
            "telephone_number": "928-425-8200",
            "fax_number": "928-425-8406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULSON",
        "first_name": "LAURA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-12",
        "last_updated": "2019-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "6466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "TENNANT",
            "middle_name": "MARIE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Globe, AZ

Sources for this page

Verify at the official NPI Registry.