Reece Kirby Hadlock, PA-C
Individual provider Active NPI Physician Assistant · Eagar, AZ
NPI 1972802528 · NPPES record last updated Jan 12, 2012
Key facts
- NPI
- 1972802528
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5006 (AZ)
- Practice address
- 606 N Main St
Eagar, AZ 85925-9813 - Phone
- (928) 333-5333
- Fax
- (928) 333-5100
- NPI assigned
- Mar 22, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- White Mountain Regional Medical Center
Banner Primary Care Physicians Arizona LLC
Practice addresses (Care Compare)
118 S Mountain Ave
Springerville, AZ 85938-5104
Phone (928) 333-4368
17900 N Porter Rd
Maricopa, AZ 85138-4228
Phone (520) 233-2500
3457 W White Mountain Blvd
Lakeside, AZ 85929-6007
Phone (928) 358-1515
680 E Deuce of Clubs
Show Low, AZ 85901-4829
Phone (928) 596-4580
Hospital & facility affiliations
- White Mountain Regional Medical Center
- Summit Healthcare Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120202000836 | AZ | Practitioner - Physician Assistant | 1658554670 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1252 | NV | MD | Behavior Technician |
| 5006 | AZ | MD | Chiropractor |
| PA1252 | NV | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Healthcare Medical Associates | Current |
Accepting new patients | |
| Banner Primary Care Physicians Arizona LLC | Current |
Accepting new patients | |
| Banner Primary Care Physicians Arizona LLC | Current |
Accepting new patients | |
| Summit Healthcare Medical Associates | Current |
Accepting new patients |
Locations
3457 W White Mountain Blvd
Lakeside, AZ 85929
Phone (888) 264-2127
17900 N Porter Rd
Maricopa, AZ 85138
Phone (520) 233-2500
101 E State Highway 260
Ste G
Payson, AZ 85541
Phone (888) 264-2127
680 E Deuce of Clubs
Show Low, AZ 85901
Phone (888) 264-2127
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5006 | AZ | Yes |
| Physician Assistant | 363A00000X | PA1252 | NV |
Addresses
Primary practice location
606 N Main St
Eagar, AZ 85925-9813
Mailing address
606 N Main St
Eagar, AZ 85925-9813
Phone (928) 333-5333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 657569 | Medicaid | AZ |
Other providers in Eagar, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.