NPIMap

Organization Active NPI

Sagebrush Medical Center, LLC

  • Internal Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1053865840
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DO2007 Issued in NV
Legal business name
SAGEBRUSH MEDICAL CENTER, LLC
Practice address
3097 E Warm Springs Rd Ste 400
Las Vegas, NV 89120-3757
Phone
(702) 790-2211
Fax
(702) 790-2316
NPI assigned
Aug 9, 2016
Last updated
Jul 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Harry Pan, D.O.NPI 1346688538
Title
Manager
Phone
(702) 790-2211

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DO2007 NV Primary

Addresses

Primary practice location

3097 E Warm Springs Rd Ste 400
Las Vegas, NV 89120-3757

Mailing address

3097 E Warm Springs Rd Ste 400
Las Vegas, NV 89120-3757
Phone (702) 790-2211

Other practice location 1

2645 W Horizon Ridge Pkwy
Ste 120
Henderson, NV 89052-2898
Phone (702) 790-2211

Other practice location 2

8660 Spring Mountain Rd Ste 103
Las Vegas, NV 89117-4101
Phone (702) 790-2211

Other identifiers 1

IdentifierTypeStateIssuer
81214000OtherTAX ID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170104001656 NV Part B Supplier - Clinic/Group Practice 6901187020 Receives reassigned benefits from 8 practitioners
Practice locations: Henderson, NV; Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

3097 E Warm Springs Rd
Ste 400
Las Vegas, NV 89120
Phone (702) 790-2211

8660 Spring Mountain Rd
Ste 103
Las Vegas, NV 89117
Phone (702) 790-2211

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": "1470700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1053865840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3097 E WARM SPRINGS RD STE 400",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891203757",
            "telephone_number": "702-790-2211",
            "fax_number": "702-790-2316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3097 E WARM SPRINGS RD STE 400",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891203757",
            "telephone_number": "702-790-2211",
            "fax_number": "702-790-2316"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2645 W Horizon Ridge Pkwy",
            "address_2": "Ste 120",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890522898",
            "country_code": "US",
            "telephone_number": "702-790-2211",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8660 Spring Mountain Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891174101",
            "country_code": "US",
            "telephone_number": "702-790-2211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAGEBRUSH MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-09",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "PAN",
        "authorized_official_first_name": "HARRY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-790-2211",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "DO2007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "81214000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; 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.