Organization Active NPI

Shirley Rheinfelder PLLC

  • Family Medicine Physician
  • Prescott Valley, AZ
National Provider Identifier
1083946610
Registry record updated Feb 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
31308 Issued in AZ
Legal business name
SHIRLEY RHEINFELDER PLLC
Practice address
3149 N Windsong Dr
Prescott Valley, AZ 86314-2240
Phone
(928) 445-6083
Fax
(928) 775-2307
NPI assigned
Feb 8, 2010
Last updated
Feb 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2010

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

Authorized official

Name
Mr. John C Moyer
Title
Manager
Phone
(928) 778-1251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 31308 AZ Primary

Addresses

Primary practice location

3149 N Windsong Dr
Prescott Valley, AZ 86314-2240

Mailing address

47 N French Dr
Prescott, AZ 86303-6247
Phone (928) 778-1251

Other identifiers 3

IdentifierTypeStateIssuer
774762MedicaidAZ
AZ0734010OtherAZBCBS
Z74731OtherAZMEDICARE ID-TYPE UNSPECIFIED

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100703000044 AZ Part B Supplier - Clinic/Group Practice 2567593775 Receives reassigned benefits from 1 practitioner
Practice locations: Prescott Valley, AZ

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
03D2027475Shirley Rheinfelder MD PLLC3149 Windsong Dr Ste a, Prescott Valley, AZ 86314Provider-performed microscopyJul 25, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1265587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265587200000",
    "number": "1083946610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 N FRENCH DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863036247",
            "telephone_number": "928-778-1251",
            "fax_number": "928-778-7834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3149 N WINDSONG DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142240",
            "telephone_number": "928-445-6083",
            "fax_number": "928-775-2307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHIRLEY RHEINFELDER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-08",
        "last_updated": "2010-02-08",
        "status": "A",
        "authorized_official_last_name": "MOYER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "928-778-1251",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "31308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "774762",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "AZ0734010",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED",
            "identifier": "Z74731",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2010; 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.