Active NPI
Novaspine Pain Institute, PLC
- Pain Medicine Physician
- Sun City West, AZ
National Provider Identifier
1154745263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pain Medicine Physician
- License
- 42990
- Legal business name
- NOVASPINE PAIN INSTITUTE, PLC
- Practice address
- 14300 W Granite Valley Dr Ste A1
Sun City West, AZ 85375-5797 - Phone
- (623) 777-4747
- Fax
- (623) 777-4748
- NPI assigned
- Feb 10, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Clifford T Baker, M.D.
- Title
- Owner
- Phone
- (623) 777-4747
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 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 42990 | AZ | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 42990 | AZ | |
| Pain Medicine (Physical Medicine & Rehabilitation) Physician | 2081P2900X | 42990 | AZ | |
| Pain Medicine Physician | 208VP0000X | 42990 | AZ | Primary |
| Interventional Pain Medicine Physician | 208VP0014X | 42990 | AZ | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | 42990 | AZ |
Addresses
Primary practice location
14300 W Granite Valley Dr Ste A1
Sun City West, AZ 85375-5797
Mailing address
PO Box 5068
Sun City West, AZ 85376-5068
Phone (623) 777-4747
Other practice location 1
13203 N 103rd Ave Ste H5
Sun City, AZ 85351-3032
Phone (623) 777-4747
Other practice location 2
17100 N 67th Ave Ste 300
Glendale, AZ 85308-3657
Phone (623) 777-4747
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 071706 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140630000941 | AZ | Part B Supplier - Clinic/Group Practice | 9931323359 |
Receives reassigned benefits from 39 practitioners Practice locations: Glendale, AZ; Sun City, AZ; Sun City West, AZ |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Durable Medical Equipment & Medical Supplies
- Sun City, AZ
- NPI 1124579628
9931323359
National Provider Directory
National Provider DirectoryLocations
3135 E Lincoln Dr
Ste A
Phoenix, AZ 85016
Phone (602) 349-5040
13203 N 103rd Ave
Ste H4
Sun City, AZ 85351
Practitioners & affiliated clinicians
Practitioners 40
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Interventional Pain Medicine Physician
- Sun City, AZ
- NPI 1235342775
AZ, Pain Medicine
-
- Interventional Pain Medicine Physician
- Sun City, AZ
- NPI 1255727889
Anesthesiology, AZ
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391990400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1708300800000",
"number": "1154745263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5068",
"city": "SUN CITY WEST",
"state": "AZ",
"postal_code": "853765068",
"telephone_number": "623-777-4747",
"fax_number": "623-777-4748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14300 W GRANITE VALLEY DR STE A1",
"city": "SUN CITY WEST",
"state": "AZ",
"postal_code": "853755797",
"telephone_number": "623-777-4747",
"fax_number": "623-777-4748"
}
],
"practiceLocations": [
{
"address_1": "13203 N 103rd Ave Ste H5",
"address_purpose": "LOCATION",
"city": "Sun City",
"state": "AZ",
"postal_code": "853513032",
"country_code": "US",
"telephone_number": "623-777-4747",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "17100 N 67th Ave Ste 300",
"address_purpose": "LOCATION",
"city": "Glendale",
"state": "AZ",
"postal_code": "853083657",
"country_code": "US",
"telephone_number": "623-777-4747",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "NOVASPINE PAIN INSTITUTE, PLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-02-10",
"last_updated": "2024-02-19",
"certification_date": "2024-02-19",
"status": "A",
"authorized_official_last_name": "BAKER",
"authorized_official_first_name": "CLIFFORD",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "623-777-4747",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Anesthesiology",
"state": "AZ",
"license": "42990",
"primary": false
},
{
"code": "207LP2900X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Anesthesiology, Pain Medicine",
"state": "AZ",
"license": "42990",
"primary": false
},
{
"code": "2081P2900X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Medicine & Rehabilitation, Pain Medicine",
"state": "AZ",
"license": "42990",
"primary": false
},
{
"code": "208VP0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Pain Medicine",
"state": "AZ",
"license": "42990",
"primary": true
},
{
"code": "208VP0014X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": "AZ",
"license": "42990",
"primary": false
},
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "AZ",
"license": "42990",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "071706",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sun City West, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2024; 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.