NPIMap

Organization Active NPI

Shannon Gray

Doing business as Vista Medical Group

  • Specialist
  • Mesa, AZ
National Provider Identifier
1245553502
Registry record updated Mar 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
36286 Issued in AZ
Legal business name
SHANNON GRAY
Doing business as
Vista Medical Group
Practice address
1111 S Stapley Dr
Suite 111
Mesa, AZ 85204-5059
Phone
(480) 398-1220
Fax
(480) 398-1230
NPI assigned
Mar 1, 2010
Last updated
Mar 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2010

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

Authorized official

Name
Miss Shannon GrayNPI 1750898714
Title
Administrator/Owner
Phone
(480) 983-4200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 36286 AZ Primary

Addresses

Primary practice location

1111 S Stapley Dr
Suite 111
Mesa, AZ 85204-5059

Mailing address

212 W Superstition Blvd
Suite 101
Apache Junction, AZ 85120-4127
Phone (480) 983-4200

Other names 1

  • VISTA MEDICAL GROUP Doing business as

National Provider Directory

National Provider Directory

Locations

1111 S Stapley Dr
Ste 111
Mesa, AZ 85204
Phone (480) 398-1220

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1267401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267401600000",
    "number": "1245553502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 W SUPERSTITION BLVD",
            "address_2": "SUITE 101",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "851204127",
            "telephone_number": "480-983-4200",
            "fax_number": "480-983-4317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 S STAPLEY DR",
            "address_2": "SUITE 111",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852045059",
            "telephone_number": "480-398-1220",
            "fax_number": "480-398-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANNON GRAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-01",
        "last_updated": "2010-03-01",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "480-983-4200",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "36286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VISTA MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 1, 2010; 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.