Unknown Individual – Medical Physician Assistant, NPI 1508835802
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
523, Rose Lane, Wickenburg, Maricopa County, Arizona, 85390, United States
SUITE 101
WICKENBURG, AZ 853901448
Phone: (602) 530-6189
Fax: (602) 548-2292
Type: Mailing
5410, West Thunderbird Road, Glendale, Maricopa County, Arizona, 85306, United States
SUITE 101
GLENDALE, AZ 853064711
Phone: (602) 530-6189
Fax: (602) 548-2292
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $24.
Total Amount is formed as General ($24) + Research ($0) + Ownership ($0) = $24.
Last reported payment date: 2023-05-16 • Largest payer in this snapshot: Abbott Laboratories ($24).
Total Amount
$24
General + Research + Ownership
Payments
1
Total payment records
General Amount
$24
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-05-16
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Abbott Laboratories | $24 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 85390)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | SC | |
| Cardiovascular Disease (Cardiology), Interventional Cardiology | AZ | |
| Orthopedic Surgery | AZ | |
| General Surgery | CA | |
| General Surgery | AZ | |
| - | AZ | |
| Nurse Practitioner | AZ | |
| Physician Assistant | AZ | |
| - | AZ | |
| Nurse Practitioner | AZ |
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