Allergy & Asthma Care of Sedona, LLC

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

30297 Issued in AZ

Legal business name

ALLERGY & ASTHMA CARE OF SEDONA, LLC

Practice address

450 S Willard St Ste 101
Cottonwood, AZ 86326-6744

Phone

(928) 284-0166

Fax

(928) 284-1810

NPI assigned

Oct 23, 2007

Organization subpart

No

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

Authorized official

Name

Gary M GoodmanNPI 1811999485

Title

Physician Owner

Phone

(314) 569-1881

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gary M Goodman, MD

  • Pediatric Allergy/Immunology Physician
  • Saint Louis, MO
  • NPI 1811999485

  AZ

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1193097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1053500207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 N EUCLID AVE UNIT 404",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631081482",
            "telephone_number": "928-284-0166",
            "fax_number": "888-435-3534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 S WILLARD ST STE 101",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863266744",
            "telephone_number": "928-284-0166",
            "fax_number": "928-284-1810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLERGY & ASTHMA CARE OF SEDONA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-23",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A",
        "authorized_official_last_name": "GOODMAN",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "314-569-1881"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology",
            "state": "AZ",
            "license": "30297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Allergy & Immunology Physician in Cottonwood, AZ
• Providers in Cottonwood, AZ by specialty
• Allergy & Immunology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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.