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JESSE HEADAPOHL FATOMA
NPI 1407743891
Nurse Practitioner - Psychiatric/Mental Health in Avondale, AZ

Active since June 19, 2025PECOS Enrolled
11770 W DAVIS LN, AVONDALE, AZ 85323(480) 217-8964 Get Directions Write a Review

NPPES record last updated: June 5, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 5, 2026, Jun 19, 2025 (2 updates tracked since 2025).

About Jesse Headapohl Fatoma NPPES

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

JESSE HEADAPOHL FATOMA (NPI 1407743891) is an individual psychiatric/mental health provider in Avondale, Arizona, licensed in Arizona (326908) and active in the NPI registry since June 2025. He is enrolled in Medicare PECOS and maintains a secondary practice location in Avondale.

NPPES Registry Identity

NPI1407743891
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameJESSE HEADAPOHL FATOMA
Location Address11770 W DAVIS LNAvondale, AZ 85323-7695
Mailing Address11770 W Davis LnAvondale, AZ 85323-7695 · (480) 217-8964
Phone(480) 217-8964
Sole ProprietorNo
Enumeration DateJune 19, 2025
Last NPPES UpdateJune 5, 20262 updates tracked since enumeration
NPPES CertifiedJune 5, 2026
✔ NPI 1407743891 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in AZ · 326908
Also ListedRegistered Nurse · Psychiatric/Mental HealthTaxonomy 163WP0808X · License RN204116 (AZ)
11770 W DAVIS LN, Avondale, AZ 85323
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Secondary Practice Location 1

Location 111770 W Davis LnAvondale, AZ 85323-7695 · Phone (480) 217-8964

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jesse Headapohl Fatoma 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85323 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
$98.00 typical visit price
range $17.72 – $137.41
Typical copayment $24.50 (range $4.43 – $34.35)
Most-billed visit code 99214
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

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

JANGAY PSYCHIATRIC SERVICES
Nurse Practitioner (Psychiatric/Mental Health)
11770 W DAVIS LN
AVONDALE, AZ 85323
Maricopa County (480) 217-8964

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 Jesse Fatoma's NPI number?

The NPI number for Jesse Fatoma is 1407743891. It was assigned to this individual provider in the NPPES registry on June 19, 2025.

Where is Jesse Fatoma located?

Jesse Fatoma practices at 11770 W Davis Ln, Avondale, AZ 85323. The listed phone number is (480) 217-8964.

What is Jesse Fatoma's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Jesse Fatoma enrolled in Medicare?

Yes. Jesse Fatoma is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jesse Fatoma was last updated on June 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.