NPIMap

Organization Active NPI

Innovative Diabetic Center, LLC

  • Family Medicine Physician
  • Scottsdale, AZ
National Provider Identifier
1235997602
Registry record updated Oct 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
INNOVATIVE DIABETIC CENTER, LLC
Practice address
10210 N 92ND St Ste 104
Scottsdale, AZ 85258-4531
Phone
(480) 493-0900
Fax
(833) 228-0846
NPI assigned
Mar 11, 2024
Last updated
Oct 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2026

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

Authorized official

Name
Amy Lorraine Hunn
Title
President
Phone
(480) 493-0900

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133N00000X
Metabolic Nutrition Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133VN1006X
Diabetes Educator Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WD0400X
Infusion Therapy Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WI0500X
Licensed Practical NurseGroup: 193200000X MULTI-SPECIALTY GROUP 164W00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X
Infusion Therapy Clinic/Center 261QI0500X
Multi-Specialty Clinic/Center 261QM1300X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

10210 N 92ND St Ste 104
Scottsdale, AZ 85258-4531

Mailing address

10210 N 92ND St Ste 104
Scottsdale, AZ 85258-4531
Phone (480) 493-0900

Other practice location 1

3625 Crossings Dr Ste C
Prescott, AZ 86305-7159
Phone (480) 493-0900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240417002315 AZ Part B Supplier - Clinic/Group Practice 5496194938 Receives reassigned benefits from 14 practitioners
Practice locations: Scottsdale, AZ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2304560Innovative Diabetic Center, LLC10210 N 92ND St, Ste 104, Scottsdale, AZ 85258Certificate of waiverMay 14, 2028
03D2345067Innovative Diabetic Center LLC3625 Crossings Dr Ste C, Prescott, AZ 86305Certificate of waiverJun 3, 2028

National Provider Directory

National Provider Directory

Locations

10210 N 92nd St
Ste 104
Scottsdale, AZ 85258
Phone (480) 493-0900

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": "1710115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791849600000",
    "number": "1235997602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10210 N 92ND ST STE 104",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584531",
            "telephone_number": "480-493-0900",
            "fax_number": "833-228-0846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10210 N 92ND ST STE 104",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584531",
            "telephone_number": "480-493-0900",
            "fax_number": "833-228-0846"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3625 Crossings Dr Ste C",
            "address_purpose": "LOCATION",
            "city": "Prescott",
            "state": "AZ",
            "postal_code": "863057159",
            "country_code": "US",
            "telephone_number": "480-493-0900",
            "fax_number": "833-972-4808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INNOVATIVE DIABETIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-11",
        "last_updated": "2026-10-13",
        "certification_date": "2026-10-13",
        "status": "A",
        "authorized_official_last_name": "HUNN",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "LORRAINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-493-0900"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WI0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Oct 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.