Banner Peoria Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

BANNER PEORIA SURGERY CENTER LLC

Practice address

13640 N Plaza del Rio Blvd Ste 135
Peoria, AZ 85381-4846

Phone

(623) 234-4766

Fax

(602) 801-3657

NPI assigned

Aug 9, 2017

Last updated

Jul 26, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

BANNER HEALTHAs reported in NPPES

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

Authorized official

Name

Matthew Cox

Title

Sr VP Finance

Phone

(602) 747-4000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Listed as

Banner Peoria Surgery CenterCCN 03C0001070

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Part of

Big Horn Family Med

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Atlas Neurosurgery and Spine PLLC

  • Neurological Surgery Physician
  • Scottsdale, AZ
  • NPI 1467979955

  Member Of

  NPD member
• Banner Health

  dba Banner Hospice of Northern Colorado

  • Community Based Hospice Care Agency
  • Greeley, CO
  • NPI 1407409964

  Member Of

  NPD member

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

{
    "created_epoch": "1502236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564099200000",
    "number": "1104341353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N CENTRAL AVE STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13640 N PLAZA DEL RIO BLVD STE 135",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814846",
            "telephone_number": "623-234-4766",
            "fax_number": "602-801-3657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER PEORIA SURGERY CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2017-08-09",
        "last_updated": "2019-07-26",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "SR VP FINANCE",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Banner Arizona Medical Clinic LTD
• Banner Health (Banner Health Center Peoria)
• Banner Health Clinic
• Banner Home Care-Arizona
• Banner Home Care-Arizona
• Banner Physician Specialists Arizona LLC
• Banner Physician Specialists Arizona LLC
• Banner Physician Specialists Arizona LLC
• Banner Physician Specialists Arizona LLC
• Banner Physician Specialists Arizona LLC

• Ambulatory Surgical Clinic/Center in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Ambulatory Surgical Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2019; 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.