NPIMap

Organization Active NPI

Landmark Medical LLC

  • Physical Medicine & Rehabilitation Physician
  • Anthem, AZ
National Provider Identifier
1144738469
Registry record updated Oct 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
46628 Issued in AZ
Legal business name
LANDMARK MEDICAL LLC
Practice address
3624 W Anthem Way Ste 108
Anthem, AZ 85086-0440
Phone
(435) 760-5896
NPI assigned
Jan 22, 2018
Organization subpart
Yes
Parent organization
LANDMARK MEDICAL LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 8, 2020

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

Authorized official

Name
Dr. Justin D Thompson
Title
Manager
Phone
(435) 760-5896

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 8503 AZ
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X 46628 AZ Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 12547 AZ
Durable Medical Equipment & Medical Supplies 332B00000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X 5090 AZ
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X AP5002 AZ

Addresses

Primary practice location

3624 W Anthem Way Ste 108
Anthem, AZ 85086-0440

Mailing address

2340 W Parkside LN Ste H107
Phoenix, AZ 85027-1274
Phone (602) 354-5310

National Provider Directory

National Provider Directory
Tax ID family
Landmark Medical LLC5 organizations share this tax ID, including this one
Part of
Landmark Medical LLC

Other organizations with this tax ID 4

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

Locations

3624 W Anthem Way
Ste 108
Anthem, AZ 85086
Phone (435) 760-5896

NPI Registry JSON

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

{
    "created_epoch": "1516579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602115200000",
    "number": "1144738469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2340 W PARKSIDE LN STE H107",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850271274",
            "telephone_number": "602-354-5310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3624 W ANTHEM WAY STE 108",
            "city": "ANTHEM",
            "state": "AZ",
            "postal_code": "850860440",
            "telephone_number": "435-760-5896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANDMARK MEDICAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LANDMARK MEDICAL LLC",
        "enumeration_date": "2018-01-22",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "435-760-5896",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "8503",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "AZ",
            "license": "46628",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "12547",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5090",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "AP5002",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anthem, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2020; 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.