NPIMap

Organization Active NPI

Medical Group of Arizona, LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Phoenix, AZ
National Provider Identifier
1366796773
Registry record updated Nov 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
29166 Issued in AZ
Legal business name
MEDICAL GROUP OF ARIZONA, LLC
Practice address
13430 N. Black Canyon Highway
Suite 100
Phoenix, AZ 85029-1310
Phone
(602) 943-9200
Fax
(602) 216-3000
NPI assigned
Nov 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2012

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

Authorized official

Name
Dr. Reginald M. Sutton, M.D.
Title
Sole Member
Phone
(480) 686-8737

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QG0300X 29166 AZ Primary

Addresses

Primary practice location

13430 N. Black Canyon Highway
Suite 100
Phoenix, AZ 85029-1310

Mailing address

4616 N 51St Ave
Suite 103
Phoenix, AZ 85031-1720
Phone (480) 686-8737

National Provider Directory

National Provider Directory

Locations

13430 N Black Canyon Hwy
Ste 100
Phoenix, AZ 85029

NPI Registry JSON

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

{
    "created_epoch": "1352246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352246400000",
    "number": "1366796773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4616 N 51ST AVE",
            "address_2": "SUITE 103",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850311720",
            "telephone_number": "480-686-8737",
            "fax_number": "602-216-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13430 N. BLACK CANYON HIGHWAY",
            "address_2": "SUITE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850291310",
            "telephone_number": "602-943-9200",
            "fax_number": "602-216-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL GROUP OF ARIZONA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-07",
        "last_updated": "2012-11-07",
        "status": "A",
        "authorized_official_last_name": "SUTTON",
        "authorized_official_first_name": "REGINALD",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "480-686-8737",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "AZ",
            "license": "29166",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Nov 7, 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.