Organization Active NPI

Bates Family Practice PLLC

  • General Practice Physician
  • Phoenix, AZ
National Provider Identifier
1336734946
Registry record updated Nov 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
BATES FAMILY PRACTICE PLLC
Practice address
520 E Bethany Home Rd
Phoenix, AZ 85012-1207
Phone
(602) 726-3301
Fax
(602) 654-3300
NPI assigned
Mar 5, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2023

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

Authorized official

Name
Gina Bates, FNPNPI 1063524791
Title
Owner
Phone
(512) 554-4523

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

520 E Bethany Home Rd
Phoenix, AZ 85012-1207

Mailing address

520 E Bethany Home Rd
Phoenix, AZ 85012-1207
Phone (602) 726-3301

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210517002574 AZ Part B Supplier - Clinic/Group Practice 4284043530 Receives reassigned benefits from 1 practitioner
Practice locations: Phoenix, AZ

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2221801Bates Family Practice520 E Bethany Home Rd, Phoenix, AZ 85012Certificate of waiverApr 22, 2027

National Provider Directory

National Provider Directory

Locations

520 E Bethany Home Rd
Phoenix, AZ 85012
Phone (602) 264-9121

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700524800000",
    "number": "1336734946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 E BETHANY HOME RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121207",
            "telephone_number": "602-726-3301",
            "fax_number": "602-654-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 E BETHANY HOME RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121207",
            "telephone_number": "602-726-3301",
            "fax_number": "602-654-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BATES FAMILY PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-05",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A",
        "authorized_official_last_name": "BATES",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-554-4523",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Nov 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.