Phoenix Spine and Joint Gilbert ASC, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PHOENIX SPINE AND JOINT GILBERT ASC, LLC

Practice address

1760 E Pecos Rd Ste 128
Gilbert, AZ 85295-3206

Phone

(602) 256-2525

Fax

(602) 256-0795

NPI assigned

Jan 15, 2021

Last updated

Jan 6, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Daniel Lieberman, MDNPI 1508868308

Title

Ceo

Phone

(602) 256-2525

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306435086. Details of each certification follow.

• CCN 03C0001444 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 03C0001444

Legal name

PHOENIX SPINE AND JOINT GILBERT,ASC, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Oct 8, 2021

Last certification

Oct 8, 2021

Ownership / control type

Proprietary

Facility address

1760 East Pecos Rd, Ste 128
Gilbert, AZ 85295

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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.

• Daniel M Lieberman, M.D.

  • Neurological Surgery Physician
  • Phoenix, AZ
  • NPI 1508868308
  NPD (past) Authorized official

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

{
    "created_epoch": "1610668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641427200000",
    "number": "1306435086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 E ARIZONA BILTMORE CIR STE D142",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850162147",
            "telephone_number": "602-256-2525",
            "fax_number": "602-256-0795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1760 E PECOS RD STE 128",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852953206",
            "telephone_number": "602-256-2525",
            "fax_number": "602-256-0795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX SPINE AND JOINT GILBERT ASC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-15",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A",
        "authorized_official_last_name": "LIEBERMAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-256-2525",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phoenix Children's Hospital
• Phoenix Diagnostic Imaging Inc
• Phoenix Foot Surgeon Inc
• Phoenix Holistic Psychiatry LLC
• Phoenix Skin and Wound Care
• Phoenix Valley Senior Care (Right at Home)
• Phoenix Vamc
• Sylvia Phommalinh, PA-C
• Declan Li Phuong
• Physical Medicine of Gilbert LLC

• Ambulatory Surgical Clinic/Center in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Ambulatory Surgical Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.