Adelante Healthcare, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Phoenix, AZ
NPI 1205200565 · NPPES record last updated Apr 28, 2023
Key facts
- NPI
- 1205200565
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 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
- Organization subpart
- No
Authorized official
- Name
- Krystal Powell
- Title
- Revenue Cycle Director
- Phone
- (623) 583-3001
Owners & managing parties with NPI records 2
-
Robert Donald Babyar, M.D.
-
Gordon Louis Grado, M.D.
Other NPIs on the same Medicare enrollment 13
Other NPIs with the same Medicare PAC ID 13
Corporate family (same tax ID) 22
Practitioners 142
-
Michelle Lenee Hill, DNP, AGNP-C
-
Sabahat Hussain, PA-C
-
Megan Nicholas, PA
-
Francisca Melissa Olibarria, FNP-C
-
Laura S Rhead, RD
-
Eugene Adel, M.D.
-
Adrienne Adkins-Provost, MSN, FNP-BC
-
Enyonam Agamasu, M.D.
-
Gaurav Aggarwal, M.D.
-
Angelica Alcala, MSN, FNP-C
-
Shireen Kay Allen-Lawson, DNP, FNP-C
-
A. Yvette Alvarez-Rooney, LPC, LISAC
-
Melissa Anderson, LCSW
-
Holly Armstrong, LCSW
-
Melody Attipoe, MSN, APRN, FNP-C
-
Maria E. Avilez, MD
-
Kareem Bannis, M.D.
-
Krista Beasley, NP
-
Brendan Beggs, M.S., LPC
-
Krysten L Begley, MSN, FNP-C
-
Diana Pinto Beltran Washington, DBH, LPC
-
Angelica M Bennett, LPC, LCPC
-
Diana P Bernardez, MSN, AGNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ
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
- Corporation · Non-profit
- Incorporated
- Jul 1, 1980 in AZ
- Enrollment address
- 500 W Thomas Rd
Ste 870
Phoenix, AZ 85013-4218
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Jan Hertzfeld |
Corporate Director |
Jun 24, 2021 | |
| Robert D Babyar |
Corporate Officer |
Sep 2, 2014 | 10% |
| Jill Rhodes |
Corporate Director |
Aug 5, 2022 | |
| Michael Ellenby |
Corporate Director |
Mar 22, 2018 | |
| Jason Reed |
Corporate Director |
Dec 21, 2017 | |
| Audrey Michelle Bohanan |
Corporate Officer |
Dec 11, 2011 | 10% |
| Guadalupe Campos |
Corporate Director |
May 27, 2021 | |
| Gordon L Grado |
Corporate Director |
Jul 23, 2015 | |
| Heather Boysel |
Corporate Director |
Jun 23, 2016 | |
| Sentari Mychale Minor |
Corporate Director |
Apr 3, 2015 | |
| Jennifer Halfar |
W-2 Managing Employee | May 4, 2020 | |
| Nelida Acosta |
Corporate Director |
Mar 18, 1986 | |
| Raymond Arvizu |
Corporate Director |
Dec 6, 2022 | |
| Pedro Cons |
Corporate Officer |
Jul 6, 2020 | 40% |
| Darrell Wayne Leonard |
Corporate Director |
Jan 22, 2015 | |
| Jonae Harrison |
Corporate Officer |
Mar 3, 2022 | 10% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Clinica Adelinte
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | |||
| Pediatrics Physician |
208000000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.