NPIMap

Organization Active NPI

Adelante Healthcare, Inc

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
National Provider Identifier
1205200565
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ADELANTE HEALTHCARE, INC
Practice address
500 W Thomas Rd Ste 870
Phoenix, AZ 85013-4218
Phone
(480) 964-2273
NPI assigned
Nov 23, 2015
Last updated
Apr 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

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

Authorized official

Name
Krystal Powell
Title
Revenue Cycle Director
Phone
(623) 583-3001

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

500 W Thomas Rd Ste 870
Phoenix, AZ 85013-4218

Mailing address

3033 N Central Ave Ste 145
Phoenix, AZ 85012-2808
Phone (623) 583-3001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031114000335 AZ Part B Supplier - Clinic/Group Practice 4688588643 Receives reassigned benefits from 250 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gila Bend, AZ; Wickenburg, AZ; Surprise, AZ; Phoenix, AZ; Peoria, AZ; Mesa, AZ; Goodyear, AZ; Buckeye, AZ
O20161221001460 AZ Part A Provider - Federally Qualified Health Center (FQHC) 4688588643 Practice locations: Phoenix, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205200565. Details of each certification follow.

Federally qualified health center certification: CCN 031943

Legal name
ADELANTE HEALTHCARE, INC
Doing business as
ADELANTE HEALTHCARE-CENTRAL PHOENIX
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 20, 2016
Last certification
Dec 20, 2016
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1980 in AZ
Enrollment address
500 W Thomas Rd
Ste 870
Phoenix, AZ 85013-4218

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Gila Bend Primary Care23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

9610 N Metro Pkwy W
Phoenix, AZ 85051
Phone (602) 843-1560

Ownership & related parties

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jan Hertzfeld Individual Corporate DirectorBoard Member Jun 24, 2021
Robert D Babyar Individual Corporate OfficerChief Medical Officer Sep 2, 2014 10%
Jill Rhodes Individual Corporate DirectorBoard Member Aug 5, 2022
Michael Ellenby Individual Corporate DirectorBoard Member Mar 22, 2018
Jason Reed Individual Corporate DirectorBoard Member Dec 21, 2017
Audrey Michelle Bohanan Individual Corporate OfficerChief People Officer Dec 11, 2011 10%
Guadalupe Campos Individual Corporate DirectorBoard Member, Secretary May 27, 2021
Gordon L Grado Individual Corporate DirectorBoard Member Jul 23, 2015
Heather Boysel Individual Corporate DirectorBoard Member Jun 23, 2016
Sentari Mychale Minor Individual Corporate DirectorBoard Member Apr 3, 2015
Jennifer Halfar Individual W-2 Managing Employee May 4, 2020
Nelida Acosta Individual Corporate DirectorBoard Member Mar 18, 1986
Raymond Arvizu Individual Corporate DirectorBoard Member Dec 6, 2022
Pedro Cons Individual Corporate OfficerChief Executive Officer Jul 6, 2020 40%
Darrell Wayne Leonard Individual Corporate DirectorBoard Member Jan 22, 2015
Jonae Harrison Individual Corporate OfficerChief Compliance Officer Mar 3, 2022 10%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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": "1448236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1205200565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3033 N CENTRAL AVE STE 145",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122808",
            "telephone_number": "623-583-3001",
            "fax_number": "623-876-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W THOMAS RD STE 870",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134218",
            "telephone_number": "480-964-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADELANTE HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-23",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "KRYSTAL",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "623-583-3001"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.