NPIMap

Individual provider Active NPI

Shane M Bezzant, M.D.

  • Diagnostic Radiology Physician
  • Phoenix, AZ
National Provider Identifier
1033190202
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
50862 Issued in AZ
Practice address
350 W Thomas Rd
Phoenix, AZ 85013-4409
Phone
(602) 406-3430
Fax
(602) 406-2340
NPI assigned
Nov 7, 2005
Last updated
Oct 24, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 50862 AZ Primary
Diagnostic Radiology Physician 2085R0202X 01058636A IN

Addresses

Primary practice location

350 W Thomas Rd
Phoenix, AZ 85013-4409

Mailing address

PO Box 33269
Phoenix, AZ 85067-3269
Phone (602) 406-4786

Other practice location 1

4915 E Baseline Rd
Gilbert, AZ 85234-2965
Phone (808) 681-2743

Other practice location 2

17040 N 51st Ave Ste 100
Glendale, AZ 85308-1496
Phone (602) 406-1164

Other practice location 3

7330 N 99th Ave Ste 200
Glendale, AZ 85307-3018
Phone (602) 406-0033

Other practice location 4

4975 N Dysart Rd Unit 100
Litchfield Park, AZ 85340-3082
Phone (602) 406-8852

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200214001603 AZ Practitioner - Diagnostic Radiology 0840477204 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
George Washington University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arizona Diagnostic Radiology Group LLCGroup PAC ID 1658796859, 62 clinicians
Sjhmc Physician ServicesGroup PAC ID 4486646197, 645 clinicians

Practice addresses (Care Compare)

4915 E Baseline Rd
Suite 116
Gilbert, AZ 85234-2966
Phone (480) 354-9200

500 W Thomas Rd
680 DHMG St Joseph's Pelvic Pain and Surg
Phoenix, AZ 85013-4235
Phone (602) 406-6017

7330 N 99TH Ave
Glendale, AZ 85307-3003

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
50862AZMDDiagnostic Radiology Physician
01058636AINMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph's Hospital and Medical Center CurrentSince Aug 30, 2020 Accepting new patients
St Josephs Pathology Current Accepting new patients
Sjhmc Physician Services CurrentSince Mar 28, 2020 Accepting new patients
Arizona Diagnostic Radiology Group, LLC Diagnostic Radiology CurrentSince Jan 1, 2025 Accepting new patients

Locations

1840 W Apache Trl
Apache Junction, AZ 85120
Phone (480) 288-6400

4915 E Baseline Rd
Gilbert, AZ 85234
Phone (480) 632-2004

4915 E Baseline Rd
Ste 116
Gilbert, AZ 85234
Phone (480) 354-9200

17040 N 51st Ave
Ste 100
Glendale, AZ 85308
Phone (602) 406-1164

7330 N 99th Ave
Ste 200
Glendale, AZ 85307
Phone (602) 406-0033

4975 N Dysart Rd
Unit 100
Litchfield Pk, AZ 85340
Phone (602) 406-8700

21300 N John Wayne Pkwy
Ste 113
Maricopa, AZ 85139
Phone (520) 568-6411

2653 W Guadalupe Rd
Ste 100
Mesa, AZ 85202
Phone (480) 455-1850

3030 N Central Ave
Ste 1001
Phoenix, AZ 85012

350 W Thomas Rd
Phoenix, AZ 85013
Phone (480) 339-5001

500 W Thomas Rd
Ste 680
Phoenix, AZ 85013
Phone (602) 406-6017

2501 E Southern Ave
Ste 811
Tempe, AZ 85282
Phone (480) 820-2021

File 56765
Los Angeles, CA 90074

Interoperability endpoints

  • Direct secure messaging: shane.bezzant.1@5919.direct.athenahealth.com

Organizations & group practices 4

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

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1033190202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33269",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850673269",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134409",
            "telephone_number": "602-406-3430",
            "fax_number": "602-406-2340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4915 E Baseline Rd",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852342965",
            "country_code": "US",
            "telephone_number": "808-681-2743",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17040 N 51st Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853081496",
            "country_code": "US",
            "telephone_number": "602-406-1164",
            "fax_number": "623-935-9495",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7330 N 99th Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853073018",
            "country_code": "US",
            "telephone_number": "602-406-0033",
            "fax_number": "602-406-0035",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4975 N Dysart Rd Unit 100",
            "address_purpose": "LOCATION",
            "city": "Litchfield Park",
            "state": "AZ",
            "postal_code": "853403082",
            "country_code": "US",
            "telephone_number": "602-406-8852",
            "fax_number": "623-935-9495",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEZZANT",
        "first_name": "SHANE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "50862",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01058636A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.