Individual provider Active NPI

Benilde Mwiseneza

  • Family Nurse Practitioner
  • Goodyear, AZ
National Provider Identifier
1013775147
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
304793 Issued in AZ
Practice address
13555 W McDowell Rd
Goodyear, AZ 85395-2624
Phone
(623) 295-1190
NPI assigned
Mar 12, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 304793 AZ Primary

Addresses

Primary practice location

13555 W McDowell Rd
Goodyear, AZ 85395-2624

Mailing address

16064 W Williams St
Goodyear, AZ 85338-3494
Phone (623) 521-1416

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240429003455 AZ Practitioner - Nurse Practitioner 5698115343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Leading Healthcare PLLCGroup PAC ID 1850652496, 42 clinicians

Practice addresses (Care Compare)

22922 N 40TH PL
Phoenix, AZ 85050-8742
Phone (347) 309-3320

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Leading Healthcare, LLC CurrentSince Mar 15, 2024 Accepting new patients

Locations

13555 W McDowell Rd
Ste 205
Goodyear, AZ 85395
Phone (623) 535-0740

13555 W McDowell Rd
Goodyear, AZ 85395
Phone (623) 932-1157

13575 W McDowell Rd
Goodyear, AZ 85395
Phone (347) 309-3320

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1013775147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16064 W WILLIAMS ST",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853383494",
            "telephone_number": "623-521-1416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13555 W MCDOWELL RD",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952624",
            "telephone_number": "623-295-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MWISENEZA",
        "first_name": "BENILDE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "304793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

Verify at the official NPI Registry.