NPIMap

Organization Active NPI

Advanced Minimally Invasive Surgical

  • Surgery Physician
  • Phoenix, AZ
National Provider Identifier
1295056919
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
ADVANCED MINIMALLY INVASIVE SURGICAL
Practice address
202 E Earll Dr Ste 360
Phoenix, AZ 85012-2677
Phone
(480) 788-5621
Fax
(480) 779-1277
NPI assigned
Jun 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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

Authorized official

Name
Kiup Alex Kim, MDNPI 1225242985
Title
Manager
Phone
(480) 299-7654

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X
Obesity Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QB0002X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

202 E Earll Dr Ste 360
Phoenix, AZ 85012-2677

Mailing address

202 E Earll Dr Ste 360
Phoenix, AZ 85012-2677
Phone (480) 788-5621

Other practice location 1

5060 N 19th Ave Ste 106
Phoenix, AZ 85015-3211
Phone (480) 788-5621

Other practice location 2

1455 W Chandler Blvd Ste B11
Chandler, AZ 85224-6128
Phone (480) 788-5621

Other practice location 3

202 E Earll Dr Ste 360
Phoenix, AZ 85012-2677
Phone (480) 788-5621

Other practice location 4

5060 N 19th Ave Ste 207
Phoenix, AZ 85015-3212
Phone (480) 788-5621

Other practice location 5

333 N Dobson Rd
Chandler, AZ 85224-4412
Phone (480) 788-5621

Other practice location 6

2737 W Baseline Rd Ste 27
Tempe, AZ 85283-1051
Phone (480) 788-5621

Other identifiers 4

IdentifierTypeStateIssuer
501341MedicaidAZ
Z139139OtherAZPTAN
P00924643OtherRR PTAN
Z139140OtherMEDICARE PTAN

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100819001272 AZ Part B Supplier - Clinic/Group Practice 4183758527 Receives reassigned benefits from 85 practitioners
1 other NPI on this enrollment
Practice locations: Casa Grande, AZ; Sun City, AZ; Scottsdale, AZ; Phoenix, AZ; Mesa, AZ; Chandler, AZ
O20220627000721 AZ DME Supplier - Physician - PodiatryDME Supplier - Physician - Interventional Pain Management 4183758527 Practice locations: Phoenix, 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

Locations

1968 N Peart Rd
Casa Grande, AZ 85122

5060 N 19th Ave
Ste 207
Phoenix, AZ 85015
Phone (480) 488-5621

2737 W Baseline Rd
Ste 27
Tempe, AZ 85283

Practitioners & affiliated clinicians

Practitioners 88

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 88

NPI Registry JSON

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

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1295056919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E EARLL DR STE 360",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122677",
            "telephone_number": "480-788-5621",
            "fax_number": "480-779-1277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E EARLL DR STE 360",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122677",
            "telephone_number": "480-788-5621",
            "fax_number": "480-779-1277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5060 N 19th Ave Ste 106",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850153211",
            "country_code": "US",
            "telephone_number": "480-788-5621",
            "fax_number": "480-779-1277",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1455 W Chandler Blvd Ste B11",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852246128",
            "country_code": "US",
            "telephone_number": "480-788-5621",
            "fax_number": "480-779-1277",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "202 E Earll Dr Ste 360",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850122677",
            "country_code": "US",
            "telephone_number": "480-788-5621",
            "fax_number": "480-779-1277",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5060 N 19th Ave Ste 207",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850153212",
            "country_code": "US",
            "telephone_number": "480-788-5621",
            "fax_number": "480-779-1277",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "333 N Dobson Rd",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852244412",
            "country_code": "US",
            "telephone_number": "480-788-5621",
            "fax_number": "480-779-1277",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2737 W Baseline Rd Ste 27",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852831051",
            "country_code": "US",
            "telephone_number": "480-788-5621",
            "fax_number": "480-779-1277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCED MINIMALLY INVASIVE SURGICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-16",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "KIUP",
        "authorized_official_middle_name": "ALEX",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "480-299-7654",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501341",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "Z139139",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR PTAN",
            "identifier": "P00924643",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z139140",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Oct 18, 2022; 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.