Active NPI
Caselli Avenue Professionals
- Cardiovascular Disease Physician
- Phoenix, AZ
National Provider Identifier
1184091704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 27801
- Legal business name
- CASELLI AVENUE PROFESSIONALS
- Practice address
- 9812 N 7TH St
9812 N 7TH Street Suite 7
Phoenix, AZ 85020-1763 - Phone
- (602) 714-6783
- Fax
- (602) 325-0125
- NPI assigned
- Aug 31, 2015
- 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
- John Sutherland, M.D.
- Title
- Ceo
- Phone
- (602) 714-6783
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 27801 | AZ | Primary |
Addresses
Primary practice location
9812 N 7TH St
9812 N 7TH Street Suite 7
Phoenix, AZ 85020-1763
Mailing address
9812 N 7TH St
9812 N 7TH Street Suite 7
Phoenix, AZ 85020-1763
Phone (602) 714-6783
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060049547 | Other | AZ | RAILROAD MEDICARE |
| WCSKQ | Other | AZ | SUN HEALTH GROUP |
| 445470 | Medicaid | AZ |
Other names 1
- North Mountain Cardio Health & Fitness
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440979200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1440979200000",
"number": "1184091704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9812 N 7TH ST",
"address_2": "9812 N 7TH STREET SUITE 7",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850201763",
"telephone_number": "602-714-6783",
"fax_number": "602-325-0125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9812 N 7TH ST",
"address_2": "9812 N 7TH STREET SUITE 7",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850201763",
"telephone_number": "602-714-6783",
"fax_number": "602-325-0125"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CASELLI AVENUE PROFESSIONALS",
"organizational_subpart": "NO",
"enumeration_date": "2015-08-31",
"last_updated": "2015-08-31",
"status": "A",
"authorized_official_last_name": "SUTHERLAND",
"authorized_official_first_name": "JOHN",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "602-714-6783",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "AZ",
"license": "27801",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "060049547",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUN HEALTH GROUP",
"identifier": "WCSKQ",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "445470",
"state": "AZ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "North Mountain Cardio Health & Fitness",
"code": "3",
"type": "Doing Business As"
}
]
}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 Aug 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.