NPIMap

Organization Active NPI

Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm

Doing business as PIMC - Ambulatory Surgical Center

  • Ambulatory Surgical Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1003083551
Registry record updated May 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Doing business as
PIMC - Ambulatory Surgical Center
Practice address
4212 North 16TH Street
Phoenix Indian Medical Center Ambulatory Surgical Cent
Phoenix, AZ 85016-5319
Phone
(602) 263-1200
Fax
(602) 263-1618
NPI assigned
May 14, 2008
Last updated
May 26, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
PHOENIX INDIAN MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Laura A Tillman, MDNPI 1932295748
Title
Cmo
Phone
(602) 263-1674

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

4212 North 16TH Street
Phoenix Indian Medical Center Ambulatory Surgical Cent
Phoenix, AZ 85016-5319

Mailing address

Pimc ASC Pobox 95460
Cleveland, OH 44193-0001
Phone (602) 581-6088

Other names 1

  • PIMC - Ambulatory Surgical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071022000302 TX Part B Supplier - Ambulatory Surgical Center 1759290901 1 other NPI on this enrollment
Practice locations: Phoenix, AZ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Dhew Ind HTLH SV HLTH S18 organizations share this tax ID, including this one
Part of
Dhew Ind HTLH SV HLTH S

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621987200000",
    "number": "1003083551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PIMC ASC POBOX 95460",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930001",
            "telephone_number": "602-581-6088",
            "fax_number": "602-263-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 NORTH 16TH STREET",
            "address_2": "PHOENIX INDIAN MEDICAL CENTER AMBULATORY SURGICAL CENT",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165319",
            "telephone_number": "602-263-1200",
            "fax_number": "602-263-1618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOENIX INDIAN MEDICAL CENTER",
        "enumeration_date": "2008-05-14",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-21",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "602-263-1674",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PIMC - Ambulatory Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.