NPIMap

Organization Active NPI

Homewood Family Medicine PLLC

  • Family Medicine Physician
  • Mesa, AZ
National Provider Identifier
1144206541
Registry record updated Oct 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3268 Issued in AZ
Legal business name
HOMEWOOD FAMILY MEDICINE PLLC
Practice address
4540 E Baseline Rd
#113
Mesa, AZ 85206-4613
Phone
(480) 558-4700
Fax
(480) 558-1936
NPI assigned
Dec 16, 2005
Last updated
Oct 18, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2007

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

Authorized official

Name
Russell Jay Homewood, DONPI 1851573109
Title
Owner
Phone
(480) 558-4700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 3268 AZ Primary

Addresses

Primary practice location

4540 E Baseline Rd
#113
Mesa, AZ 85206-4613

Mailing address

PO Box 1927
Gilbert, AZ 85299-1927
Phone (480) 558-4700

Other identifiers 1

IdentifierTypeStateIssuer
423997MedicaidAZ

National Provider Directory

National Provider Directory

Locations

4540 E Baseline Rd
Ste 113
Mesa, AZ 85206
Phone (480) 558-4700

Practitioners & affiliated clinicians

Practitioners 1

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": "1134691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192665600000",
    "number": "1144206541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1927",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852991927",
            "telephone_number": "480-558-4700",
            "fax_number": "480-558-1936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 E BASELINE RD",
            "address_2": "#113",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064613",
            "telephone_number": "480-558-4700",
            "fax_number": "480-558-1936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMEWOOD FAMILY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-16",
        "last_updated": "2007-10-18",
        "status": "A",
        "authorized_official_last_name": "HOMEWOOD",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-558-4700",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "3268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "423997",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.