NPIMap

Organization Active NPI

Southwest Neurology and Sleep Medicine LLC

  • Neurology Physician
  • Phoenix, AZ
National Provider Identifier
1104122621
Registry record updated Apr 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
SOUTHWEST NEUROLOGY AND SLEEP MEDICINE LLC
Practice address
2401 W Glendale Ave Ste 203
Phoenix, AZ 85021-7677
Phone
(602) 772-5770
Fax
(602) 772-5771
NPI assigned
Jan 31, 2011
Organization subpart
Yes
Parent organization
SOUTHWEST NEUROLOGY AND SLEEP MEDICINE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 23, 2019

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

Authorized official

Name
Sumaira Doorani
Title
Manager
Phone
(602) 772-5770

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
Sleep Medicine (Family Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QS1201X
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

2401 W Glendale Ave Ste 203
Phoenix, AZ 85021-7677

Mailing address

2401 W Glendale Ave Ste 203
Phoenix, AZ 85021-7677
Phone (602) 772-5770

Other identifiers 2

IdentifierTypeStateIssuer
Z143146OtherAZPTAN
8293938MedicaidWA

Other names 1

  • Bluesky Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110218000603 AZ Part B Supplier - Clinic/Group Practice 9436330701 Receives reassigned benefits from 8 practitioners
Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory
Part of
Southwest Neurology and Sleep Medicine LLC

Locations

2401 W Glendale Ave
Ste 203
Phoenix, AZ 85021
Phone (602) 319-0296

2401 W Glendale Ave
Phoenix, AZ 85021

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1296432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555977600000",
    "number": "1104122621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 W GLENDALE AVE STE 203",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850217677",
            "telephone_number": "602-772-5770",
            "fax_number": "602-772-5771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W GLENDALE AVE STE 203",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850217677",
            "telephone_number": "602-772-5770",
            "fax_number": "602-772-5771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST NEUROLOGY AND SLEEP MEDICINE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHWEST NEUROLOGY AND SLEEP MEDICINE LLC",
        "enumeration_date": "2011-01-31",
        "last_updated": "2019-04-23",
        "status": "A",
        "authorized_official_last_name": "DOORANI",
        "authorized_official_first_name": "SUMAIRA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "602-772-5770"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS1201X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "Z143146",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8293938",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bluesky Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.