NPIMap

Organization Active NPI

Canyon Pain and Spine

  • Interventional Pain Medicine Physician
  • Glendale, AZ
National Provider Identifier
1104590512
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
CANYON PAIN AND SPINE
Practice address
6320 W Union Hills Dr Ste A270
Glendale, AZ 85308-7175
Phone
(480) 561-5000
NPI assigned
Aug 9, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2021

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

Authorized official

Name
Kirk George Bowden, DO
Title
Owner
Phone
(480) 889-0255

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

6320 W Union Hills Dr Ste A270
Glendale, AZ 85308-7175

Mailing address

6320 W Union Hills Dr Ste A270
Glendale, AZ 85308-7175

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210922001669 AZ DME Supplier - Physician - Anesthesiology 3870992647 Practice locations: Glendale, AZ

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

6320 W Union Hills Dr
Ste A270
Glendale, AZ 85308
Phone (480) 435-9100

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DGJDCD

NPI Registry JSON

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

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628467200000",
    "number": "1104590512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6320 W UNION HILLS DR STE A270",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853087175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6320 W UNION HILLS DR STE A270",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853087175",
            "telephone_number": "480-561-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON PAIN AND SPINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-09",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A",
        "authorized_official_last_name": "BOWDEN",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-889-0255",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; 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.