NPIMap

Organization Active NPI

Pinnacle Family Medicine PLC

  • Family Medicine Physician
  • Peoria, AZ
National Provider Identifier
1093590341
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PINNACLE FAMILY MEDICINE PLC
Practice address
21753 N 77TH Ave
Peoria, AZ 85382-2110
Phone
(623) 935-9600
Fax
(623) 935-9602
NPI assigned
Aug 25, 2023
Organization subpart
Yes
Parent organization
PINNACLE FAMILY MEDICINE, PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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

Authorized official

Name
Stacey Engstrom
Title
Practice Manager
Phone
(623) 935-9600

Specialties & licenses 1

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

Addresses

Primary practice location

21753 N 77TH Ave
Peoria, AZ 85382-2110

Mailing address

21753 N 77TH Ave
Peoria, AZ 85382-2110
Phone (623) 935-9600

National Provider Directory

National Provider Directory
Part of
Pinnacle Family Medicine PLC

Locations

21753 N 77th Ave
Peoria, AZ 85382
Phone (623) 935-9600

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 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1692921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692921600000",
    "number": "1093590341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21753 N 77TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822110",
            "telephone_number": "623-935-9600",
            "fax_number": "623-935-9602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21753 N 77TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822110",
            "telephone_number": "623-935-9600",
            "fax_number": "623-935-9602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINNACLE FAMILY MEDICINE PLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PINNACLE FAMILY MEDICINE, PLC",
        "enumeration_date": "2023-08-25",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A",
        "authorized_official_last_name": "ENGSTROM",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "623-935-9600"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; 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.