NPIMap

Organization Active NPI

Southwest Network

  • Community/Behavioral Health Agency
  • Peoria, AZ
National Provider Identifier
1124275953
Registry record updated Jun 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
OTC6188 Issued in AZ
Legal business name
SOUTHWEST NETWORK
Practice address
9051 W Kelton LN
Suite 13
Peoria, AZ 85382-3533
Phone
(623) 815-5700
Fax
(623) 815-5759
NPI assigned
Aug 22, 2008
Last updated
Jun 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2020

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

Authorized official

Name
Ms. Amy B. Henning
Title
Chief Executive Officer
Phone
(602) 285-4340

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X OTC6188 AZ
Community/Behavioral Health Agency 251S00000X OTC6188 AZ Primary

Addresses

Primary practice location

9051 W Kelton LN
Suite 13
Peoria, AZ 85382-3533

Mailing address

2700 N Central Ave
Suite 1050
Phoenix, AZ 85004-1133
Phone (602) 266-8402

Other identifiers 2

IdentifierTypeStateIssuer
Z127516OtherAZMEDICARE PTAN
425250MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070613000698 AZ Part B Supplier - Clinic/Group Practice 2567560659 Receives reassigned benefits from 43 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phoenix, AZ; Peoria, AZ; Chandler, AZ

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Sreenivasa R Pinnamaneni MD9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1840 N 95th Ave
Ste 132
Phoenix, AZ 85037
Phone (623) 932-6950

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1219363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591142400000",
    "number": "1124275953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 N CENTRAL AVE",
            "address_2": "SUITE 1050",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041133",
            "telephone_number": "602-266-8402",
            "fax_number": "602-264-0887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9051 W KELTON LN",
            "address_2": "SUITE 13",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853823533",
            "telephone_number": "623-815-5700",
            "fax_number": "623-815-5759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-22",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A",
        "authorized_official_last_name": "HENNING",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "602-285-4340",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "AZ",
            "license": "OTC6188",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "OTC6188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z127516",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "425250",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; 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.