Active NPI
Brent Nelson, D.O.
- Family Medicine Physician
- Phoenix, AZ
National Provider Identifier
1326215617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4344
- Practice address
- 5040 N 15TH Ave
Suite 202
Phoenix, AZ 85015-3328 - Phone
- (602) 248-0123
- Fax
- (602) 248-8506
- NPI assigned
- May 15, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4344 | AZ | Primary |
Addresses
Primary practice location
5040 N 15TH Ave
Suite 202
Phoenix, AZ 85015-3328
Mailing address
5040 N 15TH Ave
Suite 202
Phoenix, AZ 85015-3328
Phone (602) 248-0123
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 425247 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4344 | AZ | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277251200000",
"number": "1326215617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5040 N 15TH AVE",
"address_2": "SUITE 202",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850153328",
"telephone_number": "602-248-0123",
"fax_number": "602-248-8506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5040 N 15TH AVE",
"address_2": "SUITE 202",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850153328",
"telephone_number": "602-248-0123",
"fax_number": "602-248-8506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "BRENT",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-15",
"last_updated": "2010-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "4344",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "425247",
"state": "AZ"
}
],
"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 Jun 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.