NPIMap

Organization Active NPI

Desert Pain and Rehab Specialists, PLLC

  • Durable Medical Equipment & Medical Supplies
  • Sierra Vista, AZ
National Provider Identifier
1144712191
Registry record updated Nov 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
DESERT PAIN AND REHAB SPECIALISTS, PLLC
Practice address
302 El Camino Real Ste E
Sierra Vista, AZ 85635-2860
Phone
(520) 335-2555
Fax
(520) 393-3467
NPI assigned
Jun 5, 2018
Organization subpart
Yes
Parent organization
DESERT PAIN AND REHAB SPECIALISTSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 6, 2019

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

Authorized official

Name
Herbert Goodman, MDNPI 1346258472
Title
Provider / Owner
Phone
(602) 944-2222

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
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

302 El Camino Real Ste E
Sierra Vista, AZ 85635-2860

Mailing address

11047 N 19TH Ave
Phoenix, AZ 85029-4816
Phone (602) 944-2222

Other identifiers 1

IdentifierTypeStateIssuer
306932MedicaidAZ

National Provider Directory

National Provider Directory
Part of
Desert Pain and Rehab Spec

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 8

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": "1528156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572998400000",
    "number": "1144712191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11047 N 19TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294816",
            "telephone_number": "602-944-2222",
            "fax_number": "602-331-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 EL CAMINO REAL STE E",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352860",
            "telephone_number": "520-335-2555",
            "fax_number": "520-393-3467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT PAIN AND REHAB SPECIALISTS, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DESERT PAIN AND REHAB SPECIALISTS",
        "enumeration_date": "2018-06-05",
        "last_updated": "2019-11-06",
        "status": "A",
        "authorized_official_last_name": "GOODMAN",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_title_or_position": "PROVIDER / OWNER",
        "authorized_official_telephone_number": "602-944-2222",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "306932",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sierra Vista, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; 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.