NPIMap

Individual provider Active NPI

Kenneth Barry Fleisch, MD

  • Emergency Medicine Physician
  • Scottsdale, AZ
National Provider Identifier
1235111600
Registry record updated Jun 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
28922 Issued in AZ
Practice address
5635 N Scottsdale Rd Ste 170
Scottsdale, AZ 85250-5945
Phone
(602) 386-9982
NPI assigned
Nov 18, 2005
Last updated
Jun 13, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 28922 AZ Primary

Addresses

Primary practice location

5635 N Scottsdale Rd Ste 170
Scottsdale, AZ 85250-5945

Mailing address

5635 N Scottsdale Rd Ste 170
Scottsdale, AZ 85250-5945
Phone (602) 386-9982

Other identifiers 6

IdentifierTypeStateIssuer
AW1436OtherAZHEALTHNET GRP
148363MedicaidAZ
453051001OtherAZGROUP HEALTH GRP
860373636OtherAZHUMANA GRP
3981220OtherAZEVERCARE GROUP
AZ0728670OtherAZBLUECROSS BLUESHIELD GRP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
28922AZMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chandler Emergency Medical Group, LLC Emergency Medicine Past Accepting new patients
Emergency Physicians Professional Association LTD Emergency Medicine Past Accepting new patients
Emergency Medical Solutions, LTD. Emergency Medicine Past Accepting new patients
Medical Services of Prescott, Inc. Emergency Medicine Past Accepting new patients
Lake Emergency Services Inc Emergency Medicine PastSince Sep 1, 1995 Accepting new patients
Payson Emergency Physicians, P.C. Emergency Medicine Past Accepting new patients
Lake Hospital System, Inc Past Accepting new patients
Anesthesia Associates, PLL Past Accepting new patients

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371081600000",
    "number": "1235111600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5635 N SCOTTSDALE RD STE 170",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852505945",
            "telephone_number": "602-386-9982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5635 N SCOTTSDALE RD STE 170",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852505945",
            "telephone_number": "602-386-9982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLEISCH",
        "first_name": "KENNETH",
        "middle_name": "BARRY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2013-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "28922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET GRP",
            "identifier": "AW1436",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "148363",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH GRP",
            "identifier": "453051001",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA GRP",
            "identifier": "860373636",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE GROUP",
            "identifier": "3981220",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD GRP",
            "identifier": "AZ0728670",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsdale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.