Active NPI
Joel Packard, CSFA
- Surgical Physician Assistant
- Flagstaff, AZ
National Provider Identifier
1972990851
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- Practice address
- 50 Pine del Dr
Flagstaff, AZ 86005-9603 - Phone
- (928) 699-6786
- NPI assigned
- Apr 18, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | |||
| Surgical Physician Assistant | 363AS0400X | Primary |
Addresses
Primary practice location
50 Pine del Dr
Flagstaff, AZ 86005-9603
Mailing address
50 Pine del Dr
Flagstaff, AZ 86005-9603
Phone (928) 699-6786
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Noraz Surgical Assists | Surgical Assistant | Past | Accepting new patients |
Organizations & group practices 1
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": "1429315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439596800000",
"number": "1972990851",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 PINE DEL DR",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860059603",
"telephone_number": "928-699-6786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 PINE DEL DR",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860059603",
"telephone_number": "928-699-6786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACKARD",
"first_name": "JOEL",
"credential": "CSFA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-04-18",
"last_updated": "2015-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.