NPIMap

Organization Active NPI

Banner Physician Super Specialists Arizona LLC

  • Durable Medical Equipment & Medical Supplies
  • Mesa, AZ
National Provider Identifier
1386462810
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC
Practice address
1432 S Dobson Rd Ste 304
Mesa, AZ 85202-4773
Phone
(480) 412-7400
NPI assigned
Oct 2, 2024
Last updated
Oct 30, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BANNER HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Authorized official

Name
Shiva BirdiNPI 1194993899
Title
Ceo BMG
Phone
(602) 747-4000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

1432 S Dobson Rd Ste 304
Mesa, AZ 85202-4773

Mailing address

2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702
Phone (602) 747-4000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250407002345 AZ DME Supplier - Multi-Specialty - Physician 7911173794 Practice locations: Mesa, AZ

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Kevin Warren22 organizations share this tax ID, including this one
Part of
M E Lee MD

Other organizations with this tax ID 21

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

View all 21

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Banner Health

    dba Banner Hospice of Northern Colorado

    • Community Based Hospice Care Agency
    • Greeley, CO
    • NPI 1407409964

    Member Of

    NPD member

Locations

1828 E Florence Blvd
Ste 142
Casa Grande, AZ 85122
Phone (520) 836-9642

3000 N Arizona Ave
Chandler, AZ 85225
Phone (480) 355-1575

5310 W Thunderbird Rd
Ste 214
Glendale, AZ 85306
Phone (602) 865-4480

5310 W Thunderbird Rd
Ste 301
Glendale, AZ 85306
Phone (480) 412-7474

5757 W Thunderbird Rd
Ste W406
Glendale, AZ 85306
Phone (480) 464-9400

1432 S Dobson Rd
Ste 301
Mesa, AZ 85202
Phone (480) 412-7120

1432 S Dobson Rd
Ste 403
Mesa, AZ 85202
Phone (480) 412-7473

9305 W Thomas Rd
Ste 380
Phoenix, AZ 85037
Phone (623) 327-4144

37100 N Gantzel Rd
Ste 113
San Tan Valley, AZ 85140
Phone (480) 325-8173

8840 E Chaparral Rd
Ste 210
Scottsdale, AZ 85250
Phone (480) 827-5370

Practitioners & affiliated clinicians

Practitioners 195

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 195

NPI Registry JSON

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

{
    "created_epoch": "1727827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1386462810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N CENTRAL AVE STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122702",
            "telephone_number": "602-747-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1432 S DOBSON RD STE 304",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024773",
            "telephone_number": "480-412-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2024-10-02",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "BIRDI",
        "authorized_official_first_name": "SHIVA",
        "authorized_official_title_or_position": "CEO BMG",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Oct 30, 2024; 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.