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A Medicare group practice based in Tempe, AZ: 3 NPIs enrolled under one PECOS associate control ID (PAC ID 8527324615), with 7 clinicians.

Medicare enrollment

Medicare enrollment files
PAC ID
8527324615The PECOS associate control ID: one enrolled organization, which may hold several NPIs
Provider type
DME Supplier - Oral Surgery - Dentist, Part B Supplier - Clinic/Group Practice
Enrolled in
AZ
Enrollments
4
Group size
6 cliniciansAs Care Compare reports it
Medicare assignment
May accept Medicare assignment
Practice locations
6In 3 places

Enrollment records 4

Enrollment IDStateProvider typeNPI
O20171106001637 AZ DME Supplier - Oral Surgery - Dentist 1083141329
O20200113000847 AZ DME Supplier - Oral Surgery - Dentist 1558910653
O20220208000068 AZ DME Supplier - Oral Surgery - Dentist 1316602527
O20221221000457 AZ Part B Supplier - Clinic/Group Practice 1083141329

NPIs in this group 3

NPPES NPI Registry

These NPI records belong to the same enrolled organization. Each has its own page.

Practice locations

Locations on the Medicare enrollment

Clinicians 7

Clinicians who reassign their Medicare benefits to this group (7) or whom Care Compare lists as members (6).

Sources for this page