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SIPONG PATAMASUCON
NPI 1316747256
Physician Assistant in Lake Havasu City, AZ

Active since March 18, 2025PECOS EnrolledAccepts Medicare Assignment
1801 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403(928) 854-5400 Get Directions Write a Review

NPPES record last updated: March 18, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Sipong Patamasucon NPPES

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

SIPONG PATAMASUCON (NPI 1316747256) is an individual physician assistant in Lake Havasu City, Arizona, licensed in Arizona (11017) and active in the NPI registry since March 2025. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1316747256
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameSIPONG PATAMASUCON
Location Address1801 MESQUITE AVELake Havasu City, AZ 86403-5668
Mailing Address9097 W Post Rd Ste 100Las Vegas, NV 89148-2417
Phone(928) 854-5400
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateMarch 18, 2025
NPPES CertifiedMarch 18, 2025
✔ NPI 1316747256 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in AZ · 11017
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1801 MESQUITE AVE, Lake Havasu City, AZ 86403
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Secondary Practice Locations 2

Location 12350 Miracle MileBullhead City, AZ 86442-7505 · Phone (928) 758-9362
Location 21815 N Stockton Hill RdKingman, AZ 86401-4667 · Phone (928) 753-9629

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Blue Cross Blue Shield of Arizona.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Sipong Patamasucon is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9032633870
PECOS Enrollment IDI20250414001839
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 86403 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$69.24 typical visit price
range $17.72 – $137.41
Typical copayment $17.31 (range $4.43 – $34.35)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 4

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

FREDERIC LUO, MD, MSEE, INC
Internal Medicine
1801 MESQUITE AVE, SUITE 102
LAKE HAVASU CITY, AZ 86403
Mohave County (480) 888-1900
SMITH TRYON FAMILY HEALTH INC D.B.A. BLUE WATER MEDICAL
Family Medicine
1801 MESQUITE AVE
LAKE HAVASU CITY, AZ 86403
Mohave County (928) 453-6963
ALICE DREYFUS APRN, FNP-BC
Nurse Practitioner (Family)
1801 MESQUITE AVE
LAKE HAVASU CITY, AZ 86403
Mohave County (928) 854-5400
DR. TEJASWI VENKATA MUDIGONDA M.D.
Dermatology (MOHS-Micrographic Surgery)
1801 MESQUITE AVE
LAKE HAVASU CITY, AZ 86403
Mohave County (928) 854-5400

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sipong Patamasucon's NPI number?

The NPI number for Sipong Patamasucon is 1316747256. It was assigned to this individual provider in the NPPES registry on March 18, 2025.

Where is Sipong Patamasucon located?

Sipong Patamasucon practices at 1801 Mesquite Ave, Lake Havasu City, AZ 86403. The listed phone number is (928) 854-5400.

What is Sipong Patamasucon's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Sipong Patamasucon enrolled in Medicare?

Yes. Sipong Patamasucon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Sipong Patamasucon accept?

Health plans from Ambetter from Arizona Complete Health and Blue Cross Blue Shield of Arizona list Sipong Patamasucon as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sipong Patamasucon was last updated on March 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.