NPIMap

Organization Active NPI

Willow Midwife Center for Birth and Wellness Az, LLC

  • Advanced Practice Midwife
  • Mesa, AZ
National Provider Identifier
1366065070
Registry record updated May 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
Legal business name
WILLOW MIDWIFE CENTER FOR BIRTH AND WELLNESS AZ, LLC
Practice address
2045 S Vineyard Ste 136
Mesa, AZ 85210-6891
Phone
(480) 565-5990
NPI assigned
May 28, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2020

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

Authorized official

Name
Diane M Ortega, CNM
Title
Owner
Phone
(480) 565-5990

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0000X
Women's Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LW0102X
Advanced Practice MidwifeGroup: 193200000X MULTI-SPECIALTY GROUP 367A00000X Primary

Addresses

Primary practice location

2045 S Vineyard Ste 136
Mesa, AZ 85210-6891

Mailing address

2045 S Vineyard Ste 136
Mesa, AZ 85210-6891

Other identifiers 1

IdentifierTypeStateIssuer
346515MedicaidAZ

Other names 1

  • Willow AZ Midwives Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address info@willowbirthcenteraz.com

National Provider Directory

National Provider Directory
Tax ID family
Willow Midwife Center for Birth and Wellness Az LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1590624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590624000000",
    "number": "1366065070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 S VINEYARD STE 136",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 S VINEYARD STE 136",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106891",
            "telephone_number": "480-565-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW MIDWIFE CENTER FOR BIRTH AND WELLNESS AZ, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-28",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A",
        "authorized_official_last_name": "ORTEGA",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-565-5990",
        "authorized_official_credential": "CNM"
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Advanced Practice Midwife",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "346515",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@willowbirthcenteraz.com",
            "affiliation": "N",
            "address_1": "2045 S Vineyard Ste 136",
            "city": "Mesa",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852106891",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Willow AZ Midwives",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; 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.