NPIMap

Organization Active NPI

Fort McDowell Yavapai Nation

Doing business as Wassaja Memorial Health Center

  • Primary Care Clinic/Center
  • Fort McDowell, AZ
National Provider Identifier
1053418533
Registry record updated May 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
FORT MCDOWELL YAVAPAI NATION
Doing business as
Wassaja Memorial Health Center
Practice address
16240 North Fort McDowell
Fort McDowell, AZ 85264-3402
Phone
(480) 789-7890
Fax
(480) 789-7894
NPI assigned
Sep 19, 2006
Last updated
May 5, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
FORT MCDOWELL YAVAPAI NATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 5, 2017

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

Authorized official

Name
Demetra Barr Reynolds, MD
Title
Medical Health Director
Phone
(480) 816-7199

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

16240 North Fort McDowell
Fort McDowell, AZ 85264-3402

Mailing address

PO Box 17779
Fountain Hills, AZ 85269-7779
Phone (480) 789-7890

Other names 1

  • Wassaja Memorial Health Center Doing business as

National Provider Directory

National Provider Directory
Part of
Fort McDowell Yavapai Nation

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

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": "1158624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493942400000",
    "number": "1053418533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17779",
            "city": "FOUNTAIN HILLS",
            "state": "AZ",
            "postal_code": "852697779",
            "telephone_number": "480-789-7890",
            "fax_number": "480-789-7894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16240 NORTH FORT MCDOWELL",
            "city": "FORT MCDOWELL",
            "state": "AZ",
            "postal_code": "852643402",
            "telephone_number": "480-789-7890",
            "fax_number": "480-789-7894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT MCDOWELL YAVAPAI NATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FORT MCDOWELL YAVAPAI NATION",
        "enumeration_date": "2006-09-19",
        "last_updated": "2017-05-05",
        "status": "A",
        "authorized_official_last_name": "BARR REYNOLDS",
        "authorized_official_first_name": "DEMETRA",
        "authorized_official_title_or_position": "MEDICAL HEALTH DIRECTOR",
        "authorized_official_telephone_number": "480-816-7199",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wassaja Memorial Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort McDowell, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.