NPIMap

Organization Active NPI

Center for Vein Restoration Az LLC

  • Surgery Physician
  • Mesa, AZ
National Provider Identifier
1215411970
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
CENTER FOR VEIN RESTORATION AZ LLC
Practice address
1500 S Dobson Rd Ste 310
Mesa, AZ 85202-4751
Phone
(855) 830-8346
Fax
(240) 473-4321
NPI assigned
Sep 19, 2018
Last updated
Apr 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Authorized official

Name
Lorena Thomas
Title
Credentialing Manager
Phone
(815) 254-1761

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Surgery Physician 208600000X Primary

Addresses

Primary practice location

1500 S Dobson Rd Ste 310
Mesa, AZ 85202-4751

Mailing address

7474 Greenway Center Dr Ste 1000
Greenbelt, MD 20770-3500
Phone (815) 254-1761

Other practice location 1

3509 S Mercy Rd Ste 101
Gilbert, AZ 85297-0442
Phone (855) 830-8346

Other practice location 2

9515 W Camelback Rd Ste 108
Phoenix, AZ 85037-1365
Phone (855) 830-8346

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181102002643 AZ Part B Supplier - Clinic/Group Practice 4688927973 Receives reassigned benefits from 13 practitioners
Practice locations: Gilbert, AZ; Phoenix, AZ; Mesa, AZ
O20190529002718 AZ DME Supplier - Physician - Emergency Medicine 4688927973 Practice locations: Mesa, AZ

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

1500 S Dobson Rd
Ste 310
Mesa, AZ 85202
Phone (480) 833-7320

9515 W Camelback Rd
Ste 108
Phoenix, AZ 85037
Phone (602) 428-0068

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": "1537315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1215411970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7474 GREENWAY CENTER DR STE 1000",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207703500",
            "telephone_number": "815-254-1761",
            "fax_number": "815-254-5431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S DOBSON RD STE 310",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024751",
            "telephone_number": "855-830-8346",
            "fax_number": "240-473-4321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3509 S Mercy Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852970442",
            "country_code": "US",
            "telephone_number": "855-830-8346",
            "fax_number": "240-473-4321",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9515 W Camelback Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850371365",
            "country_code": "US",
            "telephone_number": "855-830-8346",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTER FOR VEIN RESTORATION AZ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-19",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "LORENA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "815-254-1761"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; 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.