Organization Active NPI

Elevate Medical Group PLLC

  • Family Nurse Practitioner
  • Mesa, AZ
National Provider Identifier
1285402040
Registry record updated Apr 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
ELEVATE MEDICAL GROUP PLLC
Practice address
2815 S Alma School Rd Ste 112
Mesa, AZ 85210-4046
Phone
(480) 506-9701
Fax
(877) 481-1550
NPI assigned
Dec 12, 2023
Last updated
Apr 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2024

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

Authorized official

Name
Kimberly Dawn Lee, FNP-CNPI 1104502590
Title
Owner
Phone
(602) 412-7677

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 Nurse Practitioner 363LF0000X Primary

Addresses

Primary practice location

2815 S Alma School Rd Ste 112
Mesa, AZ 85210-4046

Mailing address

2815 S Alma School Rd Ste 112
Mesa, AZ 85210-4046
Phone (480) 506-9701

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240319003834 AZ Part B Supplier - Clinic/Group Practice 0345687828 Receives reassigned benefits from 1 practitioner
Practice locations: Mesa, 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
03D2308359Elevate Medical Group PLLC2815 S Alma School Rd Ste 112, Mesa, AZ 85210Certificate of waiverJul 24, 2026

National Provider Directory

National Provider Directory

Locations

2815 S Alma School Rd
Ste 112
Mesa, AZ 85210
Phone (480) 221-2227

Practitioners & affiliated clinicians

Practitioners 6

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": "1702339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711929600000",
    "number": "1285402040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2815 S ALMA SCHOOL RD STE 112",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852104046",
            "telephone_number": "480-506-9701",
            "fax_number": "877-481-1550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2815 S ALMA SCHOOL RD STE 112",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852104046",
            "telephone_number": "480-506-9701",
            "fax_number": "877-481-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATE MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-12",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-412-7677",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 1, 2024; 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.