NPIMap

Organization Active NPI

Paradise Valley Allergy Assoc LTD

  • Allergy Physician
  • Phoenix, AZ
National Provider Identifier
1356414346
Registry record updated Mar 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
License
11856 Issued in AZ
Legal business name
PARADISE VALLEY ALLERGY ASSOC LTD
Practice address
20940 N Tatum Blvd
Ste 205
Phoenix, AZ 85050-7260
Phone
(480) 991-1930
Fax
(480) 443-8196
NPI assigned
Nov 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2012

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

Authorized official

Name
Dr. Richard George Keightley, MD
Title
Ceo
Phone
(480) 991-1930

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207KA0200X 11856 AZ Primary
Pediatric Allergy/Immunology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2080P0201X 11856 AZ

Addresses

Primary practice location

20940 N Tatum Blvd
Ste 205
Phoenix, AZ 85050-7260

Mailing address

20940 N Tatum Blvd
Ste 205
Phoenix, AZ 85050-7260
Phone (480) 991-1930

Other identifiers 5

IdentifierTypeStateIssuer
4022160OtherAZAETNA PPO
0200027OtherAZUNITED HEATH CARE
1Z2992OtherAZHEALTHNET
2572627OtherAZAETNA HMO
AZ0027920OtherAZBCBS

National Provider Directory

National Provider Directory

Locations

20940 N Tatum Blvd
Ste 205
Phoenix, AZ 85050
Phone (480) 491-1930

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/5082/brand/1/csg/1/fhir/r4

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331683200000",
    "number": "1356414346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20940 N TATUM BLVD",
            "address_2": "STE 205",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850507260",
            "telephone_number": "480-991-1930",
            "fax_number": "480-443-8196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20940 N TATUM BLVD",
            "address_2": "STE 205",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850507260",
            "telephone_number": "480-991-1930",
            "fax_number": "480-443-8196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARADISE VALLEY ALLERGY ASSOC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2012-03-14",
        "status": "A",
        "authorized_official_last_name": "KEIGHTLEY",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-991-1930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": "AZ",
            "license": "11856",
            "primary": true
        },
        {
            "code": "2080P0201X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "AZ",
            "license": "11856",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "4022160",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEATH CARE",
            "identifier": "0200027",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "1Z2992",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "2572627",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "AZ0027920",
            "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 Mar 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.