NPIMap

Organization Active NPI

Banner Physician Super Specialists Arizona LLC

  • Durable Medical Equipment & Medical Supplies
  • Glendale, AZ
National Provider Identifier
1346062205
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC
Practice address
5601 W Eugie Ave Ste 100
Glendale, AZ 85304-1256
Phone
(602) 865-4510
NPI assigned
Oct 30, 2024
Last updated
Oct 30, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BANNER HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Authorized official

Name
Shiva Birdi
Title
Ceo BMG
Phone
(602) 747-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary

Addresses

Primary practice location

5601 W Eugie Ave Ste 100
Glendale, AZ 85304-1256

Mailing address

2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702
Phone (602) 747-4000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250225000909 AZ DME Supplier - Multi-Specialty - Physician 7911173794 Practice locations: Glendale, AZ

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Banner Physician Super Specialists Arizona LLC4 organizations share this tax ID, including this one
Part of
M E Lee MD

Other organizations with this tax ID 3

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Banner Health

    dba Banner Hospice of Northern Colorado

    • Community Based Hospice Care Agency
    • Greeley, CO
    • NPI 1407409964

    Member Of

    NPD member

NPI Registry JSON

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

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1346062205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N CENTRAL AVE STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122702",
            "telephone_number": "602-747-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 W EUGIE AVE STE 100",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853041256",
            "telephone_number": "602-865-4510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2024-10-30",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "BIRDI",
        "authorized_official_first_name": "SHIVA",
        "authorized_official_title_or_position": "CEO BMG",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.