Organization Active NPI

West Sedona Family Practice PLLC

  • Physician Assistant
  • Sedona, AZ
National Provider Identifier
1114384609
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4243 Issued in AZ
Legal business name
WEST SEDONA FAMILY PRACTICE PLLC
Practice address
2155 W State Route 89a Ste 116
Sedona, AZ 86336-5415
Phone
(928) 204-2540
Fax
(928) 204-9070
NPI assigned
Jan 28, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Authorized official

Name
Barbara A Cline, PA-CNPI 1164446043
Title
Physician Assistant
Phone
(928) 204-2540

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X 4243 AZ Primary

Addresses

Primary practice location

2155 W State Route 89a Ste 116
Sedona, AZ 86336-5415

Mailing address

2155 W State Route 89a Ste 116
Sedona, AZ 86336-5415
Phone (928) 204-2540

Other identifiers 2

IdentifierTypeStateIssuer
E7287ZOtherPROVIDER #
1164446043OtherAZINDIVIDUAL NPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160217000532 AZ Part B Supplier - Clinic/Group Practice 1355646126 Receives reassigned benefits from 2 practitioners
Practice locations: Sedona, AZ

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2114996West Sedona Family Practice2155 W State Route 89a, #116, Sedona, AZ 86336Certificate of waiverJun 23, 2028

National Provider Directory

National Provider Directory

Locations

2155 W State Route 89A
Ste 116
Sedona, AZ 86336
Phone (928) 204-2540

2155 W State Route 89A
Ste 113
Sedona, AZ 86336
Phone (602) 282-2964

120 Northview Rd
Ste A
Sedona, AZ 86336
Phone (928) 204-2540

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/13650/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 5

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": "1453939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734307200000",
    "number": "1114384609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2155 W STATE ROUTE 89A STE 116",
            "city": "SEDONA",
            "state": "AZ",
            "postal_code": "863365415",
            "telephone_number": "928-204-2540",
            "fax_number": "928-204-9070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 W STATE ROUTE 89A STE 116",
            "city": "SEDONA",
            "state": "AZ",
            "postal_code": "863365415",
            "telephone_number": "928-204-2540",
            "fax_number": "928-204-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST SEDONA FAMILY PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-28",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A",
        "authorized_official_last_name": "CLINE",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "928-204-2540",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "4243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER #",
            "identifier": "E7287Z",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1164446043",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sedona, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.