Heritage Technologies, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

HERITAGE TECHNOLOGIES, LLC

Doing business as

Desert Grove Family Medical

Practice address

1855 N Stapley Dr
Mesa, AZ 85203-3002

Phone

(480) 834-7546

Fax

(480) 833-8313

NPI assigned

May 9, 2006

Last updated

Nov 26, 2024By the provider in NPPES

Organization subpart

No

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

Addresses

Other names 1

• Desert Grove Family Medical Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 42

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.

• Katie Marie Andrusaitis, DNP, APRN, FNP-BC

  • Family Nurse Practitioner
  • Tempe, AZ
  • NPI 1922735521
  Medicare reassignment NPD
• Mohammad K Dardari, M.D.

  • Internal Medicine Physician
  • Peoria, AZ
  • NPI 1467405357

  Family Medicine

  Medicare reassignment NPD
• Richard James Dinsdale, MD

  • Family Medicine Physician
  • Mesa, AZ
  • NPI 1487617718
  Medicare reassignment NPD
• Robert Michael Ellis, NP

  • Family Nurse Practitioner
  • Gilbert, AZ
  • NPI 1902284599
  Medicare reassignment NPD
• Sahan Joseph Emmanuel, D.O.

  • Family Medicine Physician
  • Queen Creek, AZ
  • NPI 1245686872
  Medicare reassignment NPD
• Rachel S Erdmann, FNP

  • Nurse Practitioner
  • Mesa, AZ
  • NPI 1437383874
  Medicare reassignment NPD
• Dana S Farris, MD

  • Family Medicine Physician
  • Mesa, AZ
  • NPI 1033214200
  Medicare reassignment NPD
• Travis Fisher, MD

  • Internal Medicine Physician
  • Mesa, AZ
  • NPI 1366536732
  Medicare reassignment NPD
• Susan Gerold-Terraza, FNP

  • Family Nurse Practitioner
  • Mesa, AZ
  • NPI 1467115246

  Family Medicine

  Medicare reassignment NPD
• Brian William Goodman, DO

  • Family Medicine Physician
  • Show Low, AZ
  • NPI 1497165732
  Medicare reassignment NPD
• Kent M Hatfield, DO

  • Family Medicine Physician
  • Gilbert, AZ
  • NPI 1811938152
  Medicare reassignment NPD
• Albert Hsia, D.O.

  • Family Medicine Physician
  • Chandler, AZ
  • NPI 1518313196
  Medicare reassignment NPD

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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Desert Grove Family Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heritage Academy Gateway, Inc.
• Heritage Academy, Inc.
• Heritage Life Center LLC (Heritage Lane Behavioral Assisted Living)
• Heritage Life Center LLC (Heritage Lane Behavioral Assisted Living)
• Heritage Spinal Care LLC
• Heritage Village 3 LLC
• Heritage Village 5 LLC
• Heritage Village 6 LLC
• Heritage Village BLDG 7
• Heritage Village BLDG 8 LLC

• Family Medicine Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Family Medicine Physician in Arizona

• 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.