NPIMap

Organization Active NPI

San Pedro Health PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sierra Vista, AZ
National Provider Identifier
1245501188
Registry record updated Apr 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
2845 Issued in AZ
Legal business name
SAN PEDRO HEALTH PLLC
Practice address
4151 La Linda Way
Suite # 102
Sierra Vista, AZ 85635-4600
Phone
(520) 515-9610
Fax
(520) 515-0031
NPI assigned
Jan 24, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2021

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

Authorized official

Name
Dr. James Phillip Reed, D.O.NPI 1790719441
Title
Manager
Phone
(520) 515-9610

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 2845 AZ Primary

Addresses

Primary practice location

4151 La Linda Way
Suite # 102
Sierra Vista, AZ 85635-4600

Mailing address

4151 La Linda Way
Suite # 102
Sierra Vista, AZ 85635-4600
Phone (520) 515-9610

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120502000659 AZ Part B Supplier - Clinic/Group Practice 5496917783 Receives reassigned benefits from 1 practitioner
Practice locations: Sierra Vista, AZ

National Provider Directory

National Provider Directory

Locations

4151 La Linda Way
Ste 102
Sierra Vista, AZ 85635
Phone (520) 515-9610

4151 La Linda Way
Sierra Vista, AZ 85635

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1327363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619740800000",
    "number": "1245501188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4151 LA LINDA WAY",
            "address_2": "SUITE # 102",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856354600",
            "telephone_number": "520-515-9610",
            "fax_number": "520-515-0031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4151 LA LINDA WAY",
            "address_2": "SUITE # 102",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856354600",
            "telephone_number": "520-515-9610",
            "fax_number": "520-515-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN PEDRO HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-24",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A",
        "authorized_official_last_name": "REED",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "PHILLIP",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "520-515-9610",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "AZ",
            "license": "2845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sierra Vista, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; 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.