NPIMap

Organization Active NPI

Cholla Medical Group, Inc

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1154443422
Registry record updated Apr 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19237 Issued in AZ
Legal business name
CHOLLA MEDICAL GROUP, INC
Practice address
10631 S 51St St Ste 8
Phoenix, AZ 85044-5225
Phone
(480) 298-9951
Fax
(866) 246-5494
NPI assigned
Apr 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2023

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

Authorized official

Name
Ralph Flores
Title
Ceo
Phone
(480) 298-9951

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 19237 AZ Primary

Addresses

Primary practice location

10631 S 51St St Ste 8
Phoenix, AZ 85044-5225

Mailing address

10631 S 51St St Ste 8
Phoenix, AZ 85044-5225
Phone (480) 298-9951

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070517000335 AZ Part B Supplier - Clinic/Group Practice 2567569056 Receives reassigned benefits from 3 practitioners
Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory

Locations

1343 N Alma School Rd
Ste 155
Chandler, AZ 85224
Phone (480) 298-9951

10631 S 51st St
Ste 8
Phoenix, AZ 85044
Phone (480) 298-9951

Practitioners & affiliated clinicians

Practitioners 105

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.

View all 105

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682553600000",
    "number": "1154443422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10631 S 51ST ST STE 8",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850445225",
            "telephone_number": "480-298-9951",
            "fax_number": "866-246-5494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10631 S 51ST ST STE 8",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850445225",
            "telephone_number": "480-298-9951",
            "fax_number": "866-246-5494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHOLLA MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A",
        "authorized_official_last_name": "FLORES",
        "authorized_official_first_name": "RALPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-298-9951"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "19237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; 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.