NPIMap

Organization Active NPI

Honorhealth Medical Group, LLC

Doing business as Dynamite Creek Medical Center

  • Family Medicine Physician
  • Cave Creek, AZ
National Provider Identifier
1346282076
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
GROUP NPI Issued in AZ
Legal business name
HONORHEALTH MEDICAL GROUP, LLC
Doing business as
Dynamite Creek Medical Center
Practice address
4712 E Dynamite Blvd
Cave Creek, AZ 85331-6243
Phone
(480) 342-8711
Fax
(480) 342-7077
NPI assigned
Jun 10, 2006
Last updated
Sep 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Authorized official

Name
Savas Petrides
Title
SVP/Ceo
Phone
(480) 696-4020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X GROUP NPI AZ Primary

Addresses

Primary practice location

4712 E Dynamite Blvd
Cave Creek, AZ 85331-6243

Mailing address

2500 W Utopia Rd Ste 100
Phoenix, AZ 85027-4172
Phone (480) 587-5314

Other names 2

  • Dynamite Creek Medical Center Doing business as
  • John C Lincoln LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031119000717 AZ Part B Supplier - Clinic/Group Practice 1557274057 Receives reassigned benefits from 518 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1346282076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 W UTOPIA RD STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850274172",
            "telephone_number": "480-587-5314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4712 E DYNAMITE BLVD",
            "city": "CAVE CREEK",
            "state": "AZ",
            "postal_code": "853316243",
            "telephone_number": "480-342-8711",
            "fax_number": "480-342-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HONORHEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "PETRIDES",
        "authorized_official_first_name": "SAVAS",
        "authorized_official_title_or_position": "SVP/CEO",
        "authorized_official_telephone_number": "480-696-4020"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "GROUP NPI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dynamite Creek Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dynamite Creek Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "John C Lincoln LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Cave Creek, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.