ELIZABETH ANN WENNERSTROM PA
NPI 1114498029
Physician Assistant - Medical in Peoria, AZ

Q: What is Elizabeth Wennerstrom's NPI number?

The NPI number for Elizabeth Wennerstrom is 1114498029. It was assigned to this individual provider in the NPPES registry on December 17, 2018.

Q: What is Elizabeth Wennerstrom's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Active since December 17, 2018PECOS Enrolled

87.65/100

CMS Quality Rating

13460 N 94TH DR STE J1, PEORIA, AZ 85381(623) 876-8816(623) 298-0168 Get Directions Write a Review

NPPES record last updated: January 18, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Nov 16, 2022, Dec 17, 2018 (2 updates tracked since 2018).

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About Elizabeth Ann Wennerstrom Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ELIZABETH ANN WENNERSTROM PA (NPI 1114498029) is an individual medical provider in Peoria, Arizona, licensed in Arizona (7262) and active in the NPI registry since December 2018. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1114498029

Entity TypeIndividualFemale

Primary Taxonomy363AM0700X

Provider Legal NameELIZABETH ANN WENNERSTROMCredential: PA

Location Address13460 N 94TH DR STE J1Peoria, AZ 85381-4264

Mailing Address13460 N 94th Dr Ste J1Peoria, AZ 85381-4264 · (623) 876-8816 · Fax (623) 298-0168

Phone(623) 876-8816

Fax(623) 298-0168

Sole ProprietorNo

Enumeration DateDecember 17, 2018

Last NPPES UpdateJanuary 18, 20242 updates tracked since enumeration

NPPES CertifiedJanuary 18, 2024

✔ NPI 1114498029 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in AZ · 7262

13460 N 94TH DR STE J1, Peoria, AZ 85381

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Other Identifiers 1

Medicaid125100AZ

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Antidote Health Plan of Arizona, Inc., Blue Cross Blue Shield of Arizona, Imperial Insurance Companies, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Elizabeth Ann Wennerstrom Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

87.65/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

100

Promoting Interoperability

100

Improvement Activities

Cost

58.84

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MOUSTAFA BANNA MD

Internal Medicine (Cardiovascular Disease)