NPIMap

Organization Active NPI

West Yavapai Guidance Clinic, Inc.

Doing business as Polara Health

  • Primary Care Clinic/Center
  • Prescott Valley, AZ
National Provider Identifier
1316212178
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
OTC 5318 Issued in AZ
Legal business name
WEST YAVAPAI GUIDANCE CLINIC, INC.
Doing business as
Polara Health
West Yavapai Primary Care
Practice address
3345 N Windsong Dr
Attn: Tina Tolliver, Suite B
Prescott Valley, AZ 86314-2283
Phone
(928) 583-6411
Fax
(928) 776-8031
NPI assigned
Mar 13, 2012
Last updated
Jun 14, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
WEST YAVAPAI GUIDANCE CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Authorized official

Name
Tamara K. Player
Title
Ceo
Phone
(928) 445-5211

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X OTC 5318 AZ Primary

Addresses

Primary practice location

3345 N Windsong Dr
Attn: Tina Tolliver, Suite B
Prescott Valley, AZ 86314-2283

Mailing address

3343 N. Windsong Dr.
Prescott Valley, AZ 86314-2283
Phone (928) 445-5211

Other identifiers 1

IdentifierTypeStateIssuer
OTC 5318OtherAZADHS MEDICAL LICENSE

Other names 2

  • Polara Health Doing business as
  • West Yavapai Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040526000422 AZ Part B Supplier - Clinic/Group Practice 3375524358 Receives reassigned benefits from 23 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Prescott, AZ; Prescott Valley, AZ; Chino Valley, AZ; Camp Verde, AZ

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
West Yavapai Guidance C15 organizations share this tax ID, including this one
Part of
West Yavapai Guidance C

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

3345 N Windsong Dr
Ste B
Prescott Valley, AZ 86314
Phone (928) 583-6411

Practitioners & affiliated clinicians

Practitioners 4

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": "1331596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623628800000",
    "number": "1316212178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3343 N. WINDSONG DR.",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142283",
            "telephone_number": "928-445-5211",
            "fax_number": "928-776-8031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3345 N WINDSONG DR",
            "address_2": "ATTN: TINA TOLLIVER, SUITE B",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142283",
            "telephone_number": "928-583-6411",
            "fax_number": "928-776-8031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST YAVAPAI GUIDANCE CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WEST YAVAPAI GUIDANCE CLINIC, INC.",
        "enumeration_date": "2012-03-13",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A",
        "authorized_official_last_name": "PLAYER",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-445-5211"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "OTC 5318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADHS MEDICAL LICENSE",
            "identifier": "OTC 5318",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Polara Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Yavapai Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.