NPIMap

Organization Active NPI

Yavapai Regional Medical Center Physician Care LLC

Doing business as Yavapai Regional Medical Center Physician Care

  • Cardiovascular Disease Physician
  • Prescott, AZ
National Provider Identifier
1255582003
Registry record updated Apr 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
35954 Issued in AZ
Legal business name
YAVAPAI REGIONAL MEDICAL CENTER PHYSICIAN CARE LLC
Doing business as
Yavapai Regional Medical Center Physician Care
Practice address
3120 Clearwater Dr
Prescott, AZ 86305-7131
Phone
(928) 771-2400
Fax
(928) 771-2650
NPI assigned
Oct 9, 2008
Last updated
Apr 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2016

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

Authorized official

Name
Mr. Lee Livin
Title
Cfo
Phone
(928) 771-5691

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X 35954 AZ Primary

Addresses

Primary practice location

3120 Clearwater Dr
Prescott, AZ 86305-7131

Mailing address

PO Box 10880
Prescott, AZ 86304-0880
Phone (928) 759-5987

Other names 1

  • Yavapai Regional Medical Center Physician Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090106000798 AZ Part B Supplier - Clinic/Group Practice 5294898987 Receives reassigned benefits from 151 practitioners
3 other NPIs on this enrollment
Practice locations: Prescott, AZ; Prescott Valley, AZ; Bagdad, AZ; Chino Valley, AZ

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Yavapai Regional Medical Center Physician Care LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

726 Gail Gardner Way
Ste A
Prescott, AZ 86305
Phone (928) 442-8660

802 Ainsworth Dr
Ste A
Prescott, AZ 86301
Phone (928) 445-6025

Practitioners & affiliated clinicians

Practitioners 171

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 171

NPI Registry JSON

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

{
    "created_epoch": "1223510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459728000000",
    "number": "1255582003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "928-759-5987",
            "fax_number": "928-458-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 CLEARWATER DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863057131",
            "telephone_number": "928-771-2400",
            "fax_number": "928-771-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YAVAPAI REGIONAL MEDICAL CENTER PHYSICIAN CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-09",
        "last_updated": "2016-04-04",
        "status": "A",
        "authorized_official_last_name": "LIVIN",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "928-771-5691",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AZ",
            "license": "35954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yavapai Regional Medical Center Physician Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; 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.