Individual provider Active NPI

Jennifer Nelson, PA

  • Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1972521953
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2789 Issued in AZ
Practice address
3929 E Bell Rd
Phoenix, AZ 85032-2112
Phone
(602) 933-5000
Fax
(818) 587-2493
NPI assigned
Jul 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 2789 AZ Primary

Addresses

Primary practice location

3929 E Bell Rd
Phoenix, AZ 85032-2112

Mailing address

PO Box 80072
City of Industry, CA 91716-8072
Phone (818) 340-9988

Other identifiers 1

IdentifierTypeStateIssuer
879364-02MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040909001023 AZ Practitioner - Physician Assistant 0840266862 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Scottsdale Emergency Associates, LTD. Physician Assistant CurrentSince Apr 1, 2018 Accepting new patients
Arizona Emergency Specialist, PC Past Accepting new patients
Paradise Valley Emergency Physicians, PC Past Accepting new patients
Valley Emergency Physicians Inc Past Accepting new patients
Arizona Post-Acute Medical Services 1 PC Past Accepting new patients

Locations

7400 E Osborn Rd
Scottsdale, AZ 85251
Phone (480) 481-4000

13737 Noel Rd
Ste 1600
Dallas, TX 75240
Phone (214) 712-2489

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972521953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80072",
            "city": "CITY OF INDUSTRY",
            "state": "CA",
            "postal_code": "917168072",
            "telephone_number": "818-340-9988",
            "fax_number": "818-587-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3929 E BELL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322112",
            "telephone_number": "602-933-5000",
            "fax_number": "818-587-2493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JENNIFER",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "879364-02",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.