NPIMap

Organization Active NPI

Kenneth G. Lawlor, DO, PLLC

  • Rheumatology Physician
  • Phoenix, AZ
National Provider Identifier
1255955191
Registry record updated Jun 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
Legal business name
KENNETH G. LAWLOR, DO, PLLC
Practice address
2060 W Whispering Wind Dr Ste 264
Phoenix, AZ 85085-2869
Phone
(623) 235-6889
Fax
(623) 235-6877
NPI assigned
Jun 6, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2020

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

Authorized official

Name
Kenneth Gayle Lawlor, DONPI 1902917289
Title
Owner
Phone
(928) 717-8838

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
Rheumatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RR0500X Primary

Addresses

Primary practice location

2060 W Whispering Wind Dr Ste 264
Phoenix, AZ 85085-2869

Mailing address

3108 Clearwater Dr Ste a
Prescott, AZ 86305-7170
Phone (928) 717-8838

Other names 1

  • Canyon State Rheumatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101202000098 AZ Part B Supplier - Clinic/Group Practice 5395931331 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Prescott, AZ; Phoenix, AZ; Lakeside, AZ

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Canyon State Rheumatology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

3111 Clearwater Dr
Ste A
Prescott, AZ 86305
Phone (928) 717-8838

Practitioners & affiliated clinicians

Practitioners 8

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": "1591401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591401600000",
    "number": "1255955191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3108 CLEARWATER DR STE A",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863057170",
            "telephone_number": "928-717-8838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 W WHISPERING WIND DR STE 264",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850852869",
            "telephone_number": "623-235-6889",
            "fax_number": "623-235-6877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH G. LAWLOR, DO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-06",
        "last_updated": "2020-06-06",
        "certification_date": "2020-06-06",
        "status": "A",
        "authorized_official_last_name": "LAWLOR",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "GAYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-717-8838",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon State Rheumatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2020; 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.