NPIMap

Organization Active NPI

Andersons Nutrition

  • Registered Dietitian
  • Mesa, AZ
National Provider Identifier
1316337652
Registry record updated May 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
1038050 Issued in AZ
Legal business name
ANDERSONS NUTRITION
Practice address
4904 S Power Rd
St 188-106
Mesa, AZ 85212
Phone
(602) 770-7611
NPI assigned
Jan 26, 2015
Last updated
May 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2018

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

Authorized official

Name
Nicole Anderson- Goodrich, MS, RD
Title
President
Phone
(602) 770-7611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X 1038050 AZ Primary

Addresses

Primary practice location

4904 S Power Rd
St 188-106
Mesa, AZ 85212

Mailing address

4904 S Power Rd
St 188-106
Mesa, AZ 85212-3609

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181107002357 AZ Part B Supplier - Clinic/Group Practice 7810252699 Receives reassigned benefits from 6 practitioners
Practice locations: Gilbert, AZ; Tempe, AZ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Andersons Nutrition2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1166 E Warner Rd
Ste 220
Gilbert, AZ 85296
Phone (623) 306-5832

4904 S Power Rd
#188106
Mesa, AZ 85212

140 Wallace Ave
#105
Downingtown, PA 19335

257 W Uwchlan Ave
Downingtown, PA 19335
Phone (484) 321-3259

Practitioners & affiliated clinicians

Practitioners 12

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": "1422230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526342400000",
    "number": "1316337652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4904 S POWER RD",
            "address_2": "ST 188-106",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852123609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4904 S POWER RD",
            "address_2": "ST 188-106",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85212",
            "telephone_number": "602-770-7611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSONS NUTRITION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-26",
        "last_updated": "2018-05-15",
        "status": "A",
        "authorized_official_last_name": "ANDERSON- GOODRICH",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-770-7611",
        "authorized_official_credential": "MS, RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "AZ",
            "license": "1038050",
            "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 May 15, 2018; 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.