NPIMap

Organization Active NPI

Stellar Family Medical Clinic LLC

  • Family Nurse Practitioner
  • Surprise, AZ
National Provider Identifier
1285408161
Registry record updated Nov 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
STELLAR FAMILY MEDICAL CLINIC LLC
Practice address
15044 W Georgia Dr
Surprise, AZ 85379-4249
Phone
(602) 637-3084
NPI assigned
Nov 10, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2023

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

Authorized official

Name
Josefina Castelo, NPNPI 1346613908
Title
Owner/ Provider
Phone
(602) 637-3084

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 PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

15044 W Georgia Dr
Surprise, AZ 85379-4249

Mailing address

15044 W Georgia Dr
Surprise, AZ 85379-4249

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240103002408 AZ Part B Supplier - Clinic/Group Practice 4284084252 Receives reassigned benefits from 2 practitioners
Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory

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": "1699574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699574400000",
    "number": "1285408161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15044 W GEORGIA DR",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853794249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15044 W GEORGIA DR",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853794249",
            "telephone_number": "602-637-3084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STELLAR FAMILY MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-10",
        "last_updated": "2023-11-10",
        "certification_date": "2023-11-10",
        "status": "A",
        "authorized_official_last_name": "CASTELO",
        "authorized_official_first_name": "JOSEFINA",
        "authorized_official_title_or_position": "OWNER/ PROVIDER",
        "authorized_official_telephone_number": "602-637-3084",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Surprise, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2023; 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.