MARISA J PUTRASAHAN PA-C
NPI 1669303780
Physician Assistant in Phoenix, AZ

Q: What is Marisa Putrasahan's NPI number?

The NPI number for Marisa Putrasahan is 1669303780. It was assigned to this individual provider in the NPPES registry on May 27, 2026.

Q: What is Marisa Putrasahan's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Marisa Putrasahan was last updated on July 30, 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.

Active since May 27, 2026PECOS Enrolled

1919 E THOMAS RD, PHOENIX, AZ 85016(602) 933-2728 Get Directions Write a Review

NPPES record last updated: July 30, 2026. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Jul 30, 2026, Jul 6, 2026, May 27, 2026 (3 updates tracked since 2026).

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About Marisa J Putrasahan Pa-c NPPES

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

MARISA J PUTRASAHAN PA-C (NPI 1669303780) is an individual physician assistant in Phoenix, Arizona, licensed in Arizona (11905) and active in the NPI registry since May 2026. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1669303780

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameMARISA J PUTRASAHANCredential: PA-C

Location Address1919 E THOMAS RDPhoenix, AZ 85016-7710

Mailing Address2108 E Thomas Rd Ste 130Phoenix, AZ 85016-0008 · (602) 933-3124

Phone(602) 933-2728

Sole ProprietorNo

Enumeration DateMay 27, 2026

Last NPPES UpdateJuly 30, 20263 updates tracked since enumeration

NPPES CertifiedJuly 30, 2026

✔ NPI 1669303780 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 · 11905

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.

1919 E THOMAS RD, Phoenix, AZ 85016

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Marisa J Putrasahan Pa-c 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 85016 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 20

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

DR. TIMUR RAGHIB M.D.

Hospitalist