Active NPI
Tracy B Peruch, DC
- Naturopath
- Glendale, AZ
National Provider Identifier
1124026307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Naturopath
- License
- 09-1105
- Practice address
- 6770 W Deer Valley Rd
#B102
Glendale, AZ 85310-5956 - Phone
- (623) 362-1950
- Fax
- (623) 572-2741
- NPI assigned
- Jul 12, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5710 | AZ | |
| Naturopath | 175F00000X | 09-1105 | AZ | Primary |
Addresses
Primary practice location
6770 W Deer Valley Rd
#B102
Glendale, AZ 85310-5956
Mailing address
6770 W Deer Valley Rd
#B102
Glendale, AZ 85310-5956
Phone (623) 362-1950
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1Z5304 | Other | AZ | HEALTH NET |
| AZ0940160 | Other | AZ | BLUE CROSS BLUE SHEILD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09-1105 | AZ | MD | Naturopath |
| 3345 | AZ | MD | Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Natural Wellness Center LLC | Chiropractor | Past | Accepting new patients |
| Phoenician Health Group LLC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Phoenix, AZ
- NPI 1417006602
-
- Chiropractor
- Phoenix, AZ
- NPI 1073745782
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238976000000",
"number": "1124026307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6770 W DEER VALLEY RD",
"address_2": "#B102",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853105956",
"telephone_number": "623-362-1950",
"fax_number": "623-572-2741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6770 W DEER VALLEY RD",
"address_2": "#B102",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853105956",
"telephone_number": "623-362-1950",
"fax_number": "623-572-2741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERUCH",
"first_name": "TRACY",
"middle_name": "B",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-12",
"last_updated": "2009-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "AZ",
"license": "5710",
"primary": false
},
{
"code": "175F00000X",
"taxonomy_group": "",
"desc": "Naturopath",
"state": "AZ",
"license": "09-1105",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET",
"identifier": "1Z5304",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHEILD",
"identifier": "AZ0940160",
"state": "AZ"
}
],
"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 Apr 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.