NPIMap

Organization Active NPI

Ceb Capital LLC

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1073986212
Registry record updated Mar 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CEB CAPITAL LLC
Practice address
4502 W Indian School Rd
Suite a-3
Phoenix, AZ 85031-2800
Phone
(623) 247-0414
Fax
(623) 247-0424
NPI assigned
Nov 10, 2015
Last updated
Mar 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2016

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

Authorized official

Name
Ivy Jones
Title
Office Manager
Phone
(623) 247-2300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

4502 W Indian School Rd
Suite a-3
Phoenix, AZ 85031-2800

Mailing address

9150 W Indian School Rd
Suite 111B
Phoenix, AZ 85037-2384
Phone (623) 247-2300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160330002570 AZ Part B Supplier - Clinic/Group Practice 0244537561 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phoenix, AZ

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D0992678Ceb Capital LLC, Dba B-Healthy Clinic4502 W Indian School Ste a-3, Phoenix, AZ 85031Certificate of waiverOct 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ceb Capital LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1447113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1073986212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9150 W INDIAN SCHOOL RD",
            "address_2": "SUITE 111B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850372384",
            "telephone_number": "623-247-2300",
            "fax_number": "623-247-1939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4502 W INDIAN SCHOOL RD",
            "address_2": "SUITE A-3",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850312800",
            "telephone_number": "623-247-0414",
            "fax_number": "623-247-0424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEB CAPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-10",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "IVY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "623-247-2300"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.