Organization Active NPI

Mingus Mountain Primary Care PLLC

  • Family Medicine Physician
  • Cottonwood, AZ
National Provider Identifier
1245991785
Registry record updated Mar 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MINGUS MOUNTAIN PRIMARY CARE PLLC
Practice address
450 S Willard St Ste 107
Cottonwood, AZ 86326-6744
Phone
(928) 848-6161
NPI assigned
Jan 6, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2023

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

Authorized official

Name
Michael Aranda, DONPI 1922065127
Title
Provider/Owner
Phone
(928) 308-3541

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

450 S Willard St Ste 107
Cottonwood, AZ 86326-6744

Mailing address

450 S Willard St Ste 107
Cottonwood, AZ 86326-6744
Phone (928) 649-6080

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220224000440 AZ Part B Supplier - Clinic/Group Practice 8426441981 Receives reassigned benefits from 1 practitioner
Practice locations: Cottonwood, 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
03D2257956Mingus Mountain Primary Care, PLLC450 S Willard St Ste 107, Cottonwood, AZ 86326Certificate of waiverApr 12, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1641427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677715200000",
    "number": "1245991785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 S WILLARD ST STE 107",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863266744",
            "telephone_number": "928-649-6080",
            "fax_number": "928-649-6091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 S WILLARD ST STE 107",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863266744",
            "telephone_number": "928-848-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINGUS MOUNTAIN PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-06",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A",
        "authorized_official_last_name": "ARANDA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "928-308-3541",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cottonwood, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; 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.