NPIMap

Organization Active NPI

Edlc, LLC

Doing business as Endocrinology, Diabetes and Longevity Center of Arizona, PLC.

  • Endocrinology, Diabetes & Metabolism Physician
  • Scottsdale, AZ
National Provider Identifier
1154804243
Registry record updated Sep 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
EDLC, LLC
Doing business as
Endocrinology, Diabetes and Longevity Center of Arizona, PLC.
Practice address
7344 E Deer Valley Rd Ste 100
Scottsdale, AZ 85255-7456
Phone
(480) 513-1042
Fax
(480) 513-1043
NPI assigned
Sep 13, 2018
Last updated
Sep 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2021

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

Authorized official

Name
Ms. Regina Ford
Title
Practice Manager
Phone
(480) 513-1042

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RE0101X Primary

Addresses

Primary practice location

7344 E Deer Valley Rd Ste 100
Scottsdale, AZ 85255-7456

Mailing address

PO Box 27973
Scottsdale, AZ 85255-0149

Other names 1

  • Endocrinology, Diabetes and Longevity Center of Arizona, PLC. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181203000921 AZ Part B Supplier - Clinic/Group Practice 8820332836 Receives reassigned benefits from 10 practitioners
Practice locations: Scottsdale, AZ

National Provider Directory

National Provider Directory

Locations

4045 W Chandler Blvd
Chandler, AZ 85226
Phone (480) 355-5437

7344 E Deer Valley Rd
Scottsdale, AZ 85255
Phone (480) 513-1042

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1154804243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27973",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852550149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7344 E DEER VALLEY RD STE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852557456",
            "telephone_number": "480-513-1042",
            "fax_number": "480-513-1043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDLC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-13",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "REGINA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "480-513-1042",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Endocrinology, Diabetes and Longevity Center of Arizona, PLC.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Endocrinology, Diabetes and Longevity Center of Arizona, PLC.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Scottsdale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; 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.