Active NPI
Ivy Lewis, FNP
- Family Nurse Practitioner
- Phoenix, AZ
National Provider Identifier
1164865663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP4956
- Practice address
- 3003 N Central Ave
Suite 800
Phoenix, AZ 85012-2902 - Phone
- (855) 821-5128
- NPI assigned
- Apr 15, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP4956 | AZ | Primary |
Addresses
Primary practice location
3003 N Central Ave
Suite 800
Phoenix, AZ 85012-2902
Mailing address
748 E Cantebria Dr
Gilbert, AZ 85296-3542
Phone (480) 650-4390
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130703000295 | AZ | Practitioner - Nurse Practitioner | 9537309091 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP4956 | AZ | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Minuteclinic LLC | Family | Current | Accepting new patients |
Locations
28138 N Tatum Blvd
Cave Creek, AZ 85331
Phone (480) 585-6097
Interoperability endpoints
- ivy.lewis.1@30710.direct.athenahealth.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467158400000",
"number": "1164865663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "748 E CANTEBRIA DR",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852963542",
"telephone_number": "480-650-4390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3003 N CENTRAL AVE",
"address_2": "SUITE 800",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850122902",
"telephone_number": "855-821-5128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "IVY",
"credential": "FNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-04-15",
"last_updated": "2016-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AZ",
"license": "AP4956",
"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 Jun 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.