NPIMap

Organization Active NPI

Duke Forage Anson Neurosurgical LLP

Doing business as The Spine and Brain Institute

  • Neurological Surgery Physician
  • Henderson, NV
National Provider Identifier
1194055442
Registry record updated Aug 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
8979 Issued in NV
Legal business name
DUKE FORAGE ANSON NEUROSURGICAL LLP
Doing business as
The Spine and Brain Institute
Practice address
861 Coronado Center Dr
Suite 200
Henderson, NV 89052-3992
Phone
(702) 896-0940
Fax
(702) 896-6173
NPI assigned
Jan 9, 2010
Last updated
Aug 31, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2015

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

Authorized official

Name
Dr. Derek Addison Duke, M.D.NPI 1619934916
Title
Partner
Phone
(702) 896-0940

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X 8979 NV Primary

Addresses

Primary practice location

861 Coronado Center Dr
Suite 200
Henderson, NV 89052-3992

Mailing address

861 Coronado Center Dr
Suite 200
Henderson, NV 89052-3992
Phone (702) 896-0940

Other identifiers 1

IdentifierTypeStateIssuer
1194055442MedicaidNV

Other names 1

  • The Spine and Brain Institute Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, AZ3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100809000517 NV Part B Supplier - Clinic/Group Practice 3375676513 Receives reassigned benefits from 13 practitioners
Practice locations: Henderson, NV; Las Vegas, NV
O20110126001197 AZ Part B Supplier - Clinic/Group Practice 3375676513 Receives reassigned benefits from 7 practitioners
Practice locations: Lake Havasu City, AZ
O20180330000508 NV DME Supplier - Physician - Neurosurgery 3375676513 Practice locations: Henderson, NV

National Provider Directory

National Provider Directory

Locations

2500 Canyon Rd
Ste C1
Bullhead City, AZ 86442
Phone (928) 444-1491

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1262995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440979200000",
    "number": "1194055442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "861 CORONADO CENTER DR",
            "address_2": "SUITE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890523992",
            "telephone_number": "702-896-0940",
            "fax_number": "702-896-6173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "861 CORONADO CENTER DR",
            "address_2": "SUITE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890523992",
            "telephone_number": "702-896-0940",
            "fax_number": "702-896-6173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUKE FORAGE ANSON NEUROSURGICAL LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-09",
        "last_updated": "2015-08-31",
        "status": "A",
        "authorized_official_last_name": "DUKE",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "ADDISON",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "702-896-0940",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "NV",
            "license": "8979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194055442",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Spine and Brain Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, NV

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.
  • 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.