NPIMap

Organization Active NPI

Gilbert Physical Medicine LLC

  • General Practice Physician
  • Gilbert, AZ
National Provider Identifier
1265708317
Registry record updated Mar 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
GILBERT PHYSICAL MEDICINE LLC
Practice address
725 W Elliot Rd
Suite 115
Gilbert, AZ 85233-5301
Phone
(480) 545-0000
Fax
(480) 545-7615
NPI assigned
Mar 22, 2012
Last updated
Mar 22, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2012

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

Authorized official

Name
Alisa WassermanNPI 1124061916
Title
Owner/Operator
Phone
(480) 545-0000

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
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

725 W Elliot Rd
Suite 115
Gilbert, AZ 85233-5301

Mailing address

725 W Elliot Rd
Suite 115
Gilbert, AZ 85233-5301
Phone (480) 545-0000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130403000425 AZ Part B Supplier - Clinic/Group Practice 2466697982 Receives reassigned benefits from 21 practitioners
Practice locations: Gilbert, AZ
O20190228002975 AZ DME Supplier - Physician - ChiropracticDME Supplier - Physician - Family Practice 2466697982 Practice locations: Gilbert, AZ

National Provider Directory

National Provider Directory

Locations

725 W Elliot Rd
Ste 115
Gilbert, AZ 85233
Phone (480) 500-6251

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1332374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332374400000",
    "number": "1265708317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 W ELLIOT RD",
            "address_2": "SUITE 115",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852335301",
            "telephone_number": "480-545-0000",
            "fax_number": "480-545-7615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 W ELLIOT RD",
            "address_2": "SUITE 115",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852335301",
            "telephone_number": "480-545-0000",
            "fax_number": "480-545-7615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILBERT PHYSICAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-22",
        "last_updated": "2012-03-22",
        "status": "A",
        "authorized_official_last_name": "WASSERMAN",
        "authorized_official_first_name": "ALISA",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "480-545-0000"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2012; 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.