NPIMap

Organization Active NPI

American Family Medicine LLC

  • Pediatrics Physician
  • Phoenix, AZ
National Provider Identifier
1164287124
Registry record updated Feb 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
AMERICAN FAMILY MEDICINE LLC
Practice address
5501 N 19TH Ave Ste 218
Phoenix, AZ 85015-2452
Phone
(602) 413-0431
NPI assigned
Feb 19, 2024
Last updated
Feb 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2024

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

Authorized official

Name
Alejandro E LopezNPI 1699021337
Title
Medical Director
Phone
(832) 454-9989

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary
Physician Assistant 363A00000X NU
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

5501 N 19TH Ave Ste 218
Phoenix, AZ 85015-2452

Mailing address

1514 W Thomas Rd
Phoenix, AZ 85015-6101

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160706000435 AZ Part B Supplier - Clinic/Group Practice 5092007427 Receives reassigned benefits from 26 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phoenix, AZ; Tempe, AZ; Tolleson, AZ

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2168693American Family Medicine, LLC5501 N 19TH Ave Suite 218, Phoenix, AZ 85015Certificate of waiverJul 7, 2027

National Provider Directory

National Provider Directory

Locations

4344 W Indian School Rd
Ste 9
Phoenix, AZ 85031
Phone (623) 271-6778

5501 N 19th Ave
Ste 218
Phoenix, AZ 85015
Phone (602) 242-1221

6502 N 35th Ave
Phoenix, AZ 85017
Phone (215) 756-2721

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IBHHAD

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708300800000",
    "number": "1164287124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 W THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850156101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 N 19TH AVE STE 218",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850152452",
            "telephone_number": "602-413-0431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "ALEJANDRO",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "832-454-9989"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "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 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.