Southwellness Medical LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SOUTHWELLNESS MEDICAL LLC

Practice address

10599 N Tatum Blvd Ste F151
Paradise Valley, AZ 85253-1053

Phone

(480) 991-9271

Fax

(844) 284-7758

NPI assigned

Aug 22, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Tyler John Southwell, MDNPI 1194980367

Title

Ceo

Phone

(480) 991-9271

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23931/brand/1/csg/1/fhir/r4

Practitioners 3

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

• Tyler John Southwell, M.D.

  • Family Medicine Physician
  • Paradise Valley, AZ
  • NPI 1194980367
  Medicare reassignment NPD Authorized official
• Brittany Marie Divito, NP

  • Family Nurse Practitioner
  • Glendale, AZ
  • NPI 1023546249
  Medicare reassignment NPD
• Lauren Preble, RN

  • Registered Nurse
  • Paradise Valley, AZ
  • NPI 1558196576
  NPD

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

{
    "created_epoch": "1566432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1366099533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10599 N TATUM BLVD STE F151",
            "city": "PARADISE VALLEY",
            "state": "AZ",
            "postal_code": "852531053",
            "telephone_number": "480-991-9271",
            "fax_number": "844-284-7758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10599 N TATUM BLVD STE F151",
            "city": "PARADISE VALLEY",
            "state": "AZ",
            "postal_code": "852531053",
            "telephone_number": "480-991-9271",
            "fax_number": "844-284-7758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWELLNESS MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-22",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "SOUTHWELL",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-991-9271",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sina. Inc
• Peter J Smith, D.C.,
• William Smith Jr., MD
• Emily Broghan Schutsky Snyder, NP
• Tyler John Southwell, M.D.
• Southwest Iom Pro LLC
• Southwest Iom, LLC
• Jerry Preston Sparks, DDS
• Speech America Learning Associate, Inc.
• Robert J. Spies, MD

• Family Medicine Physician in Paradise Valley, AZ
• Providers in Paradise Valley, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.