Active NPI
Charles Redmond Breed, MD
- Specialist
- Tempe, AZ
National Provider Identifier
1104813872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 10034
- Practice address
- 2055 E Southern Ave
Suite F
Tempe, AZ 85282-7507 - Phone
- (480) 897-8484
- Fax
- (480) 897-8631
- NPI assigned
- Sep 28, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 10034 | AZ | Primary |
Addresses
Primary practice location
2055 E Southern Ave
Suite F
Tempe, AZ 85282-7507
Mailing address
2055 E Southern Ave
Suite F
Tempe, AZ 85282-7507
Phone (480) 897-8484
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 628739 | Other | AZ | VA BCBS |
| 00004310 | Other | AZ | BANNER HEALTH PLANS |
| 1Z1867 | Other | AZ | HEALTHNET |
| 207713 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040830000735 | AZ | Practitioner - Cardiovascular Disease (Cardiology) | 0941275374 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190851200000",
"number": "1104813872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2055 E SOUTHERN AVE",
"address_2": "SUITE F",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852827507",
"telephone_number": "480-897-8484",
"fax_number": "480-897-8631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2055 E SOUTHERN AVE",
"address_2": "SUITE F",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852827507",
"telephone_number": "480-897-8484",
"fax_number": "480-897-8631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREED",
"first_name": "CHARLES",
"middle_name": "REDMOND",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-28",
"last_updated": "2007-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AZ",
"license": "10034",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA BCBS",
"identifier": "628739",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BANNER HEALTH PLANS",
"identifier": "00004310",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "1Z1867",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "207713",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.