NPIMap

Organization Active NPI

Grand Canyon Anesthesia LLC

  • Anesthesiology Physician
  • Scottsdale, AZ
National Provider Identifier
1356822902
Registry record updated Aug 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
GRAND CANYON ANESTHESIA LLC
Practice address
9787 N 91St St Ste 103
Scottsdale, AZ 85258-5088
Phone
(480) 657-0889
NPI assigned
Aug 22, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2025

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

Authorized official

Name
Jeff Perry
Title
VP of RCM
Phone
(502) 418-4700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

9787 N 91St St Ste 103
Scottsdale, AZ 85258-5088

Mailing address

PO Box 737732
Dallas, TX 75373-7732
Phone (888) 717-5383

Other identifiers 1

IdentifierTypeStateIssuer
426804MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180928002378 AZ Part B Supplier - Clinic/Group Practice 3678824752 Receives reassigned benefits from 101 practitioners
Practice locations: Glendale, AZ; Scottsdale, AZ; Phoenix, AZ; Mesa, AZ; Laveen, AZ; Goodyear, AZ; Gilbert, AZ; Chandler, AZ

National Provider Directory

National Provider Directory

Locations

3668 W Anthem Way
Ste 162
Anthem, AZ 85086
Phone (623) 323-7885

2095 W Pecos Rd
Chandler, AZ 85224
Phone (480) 292-9575

1831 E Queen Creek Rd
#119
Chandler, AZ 85286

805 E Warner Rd
Ste 102
Chandler, AZ 85225
Phone (480) 732-0042

1501 N Gilbert Rd
Ste 17
Gilbert, AZ 85234

1760 E Pecos Rd
Ste 128
Gilbert, AZ 85295
Phone (602) 343-2900

2223 E Baseline Rd
Gilbert, AZ 85234
Phone (480) 289-5266

6206 W Bell Rd
Glendale, AZ 85308
Phone (602) 978-5999

1114 S Higley Rd
#101A
Mesa, AZ 85206
Phone (480) 264-2295

2626 E University Dr
Ste 110
Mesa, AZ 85213
Phone (480) 526-5300

9100 N 2nd St
Ste 201
Phoenix, AZ 85020
Phone (602) 242-1556

37100 N Gantzel Rd
Ste 100
Queen Creek, AZ 85140

9755 N 90th St
Ste C120
Scottsdale, AZ 85258
Phone (480) 391-7631

Practitioners & affiliated clinicians

Practitioners 119

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

View all 119

NPI Registry JSON

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

{
    "created_epoch": "1534896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754870400000",
    "number": "1356822902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 737732",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753737732",
            "telephone_number": "888-717-5383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9787 N 91ST ST STE 103",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852585088",
            "telephone_number": "480-657-0889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND CANYON ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-22",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "VP OF RCM",
        "authorized_official_telephone_number": "502-418-4700"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "426804",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsdale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; 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.