NPIMap

Organization Active NPI

Heritage Technologies, LLC

  • Family Medicine Physician
  • Mesa, AZ
National Provider Identifier
1093764938
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HERITAGE TECHNOLOGIES, LLC
Practice address
1855 N Stapley Dr
Mesa, AZ 85203-3002
Phone
(480) 834-7546
Fax
(480) 833-8313
NPI assigned
May 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Authorized official

Name
Michelle Dinsdale
Title
Executive Director
Phone
(480) 834-7546

Specialties & licenses 1

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

Addresses

Primary practice location

1855 N Stapley Dr
Mesa, AZ 85203-3002

Mailing address

1855 N Stapley Dr
Mesa, AZ 85203-3002
Phone (480) 834-7546

Other practice location 1

20928 E Heritage Loop Rd Ste 106
Queen Creek, AZ 85142-3900
Phone (480) 834-7546

Other practice location 2

1492 S Mill Ave Ste 101
Tempe, AZ 85281-5660
Phone (480) 834-7546

Other practice location 3

10238 E Hampton Ave Ste 508
Mesa, AZ 85209-3321
Phone (480) 834-7546

Other practice location 4

10238 E Hampton Ave Ste 506
Mesa, AZ 85209-3321
Phone (480) 834-7546

Other practice location 5

5656 S Power Rd Ste 126
Gilbert, AZ 85295-8489
Phone (480) 834-7546

Other identifiers 1

IdentifierTypeStateIssuer
633795MedicaidAZ

Other names 1

  • Desert Grove Family Medical Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040526000631 AZ Part B Supplier - Clinic/Group Practice 5193628485 Receives reassigned benefits from 30 practitioners
Practice locations: Tempe, AZ; Queen Creek, AZ; Mesa, AZ; Gilbert, AZ; Chandler, 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
03D0930501Desert Grove Family Medical1855 N Stapley Dr, Mesa, AZ 85203Certificate of waiverJul 14, 2027

National Provider Directory

National Provider Directory

Locations

11518 E Apache Trl
Ste 112
Apache Junction, AZ 85120

5656 S Power Rd
Ste 126
Gilbert, AZ 85295

1855 N Stapley Dr
Mesa, AZ 85203
Phone (480) 545-0031

10238 E Hampton Ave
Ste 506
Mesa, AZ 85209
Phone (928) 487-5051

20928 E Heritage Loop Rd
Ste 106
Queen Creek, AZ 85142

1492 S Mill Ave
Ste 101
Tempe, AZ 85281
Phone (480) 257-2740

Practitioners & affiliated clinicians

Practitioners 42

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

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1093764938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 N STAPLEY DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852033002",
            "telephone_number": "480-834-7546",
            "fax_number": "480-833-8313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 N STAPLEY DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852033002",
            "telephone_number": "480-834-7546",
            "fax_number": "480-833-8313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20928 E Heritage Loop Rd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Queen Creek",
            "state": "AZ",
            "postal_code": "851423900",
            "country_code": "US",
            "telephone_number": "480-834-7546",
            "fax_number": "480-833-8313",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1492 S Mill Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852815660",
            "country_code": "US",
            "telephone_number": "480-834-7546",
            "fax_number": "480-833-8313",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10238 E Hampton Ave Ste 508",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852093321",
            "country_code": "US",
            "telephone_number": "480-834-7546",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10238 E Hampton Ave Ste 506",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852093321",
            "country_code": "US",
            "telephone_number": "480-834-7546",
            "fax_number": "480-833-8313",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5656 S Power Rd Ste 126",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852958489",
            "country_code": "US",
            "telephone_number": "480-834-7546",
            "fax_number": "480-833-8313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HERITAGE TECHNOLOGIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "DINSDALE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "480-834-7546"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "633795",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Desert Grove Family Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; 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.