NPIMap

Organization Active NPI

Banner Physician Super Specialists Arizona LLC

  • Multi-Specialty Clinic/Center
  • San Tan Valley, AZ
National Provider Identifier
1396014403
Registry record updated Apr 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC
Practice address
37100 N Gantzel Rd Ste 214
San Tan Valley, AZ 85140-7353
Phone
(480) 412-9400
NPI assigned
Dec 19, 2011
Last updated
Apr 16, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
BANNER MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 16, 2026

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

Authorized official

Name
Shiva Birdi
Title
Ceo
Phone
(602) 747-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

37100 N Gantzel Rd Ste 214
San Tan Valley, AZ 85140-7353

Mailing address

2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702

Other practice location 1

1760 E Florence Blvd Ste 100
Casa Grande, AZ 85122-4765
Phone (520) 374-6505

Other practice location 2

37000 N Gantzel Rd
Queen Creek, AZ 85140-7303
Phone (480) 397-4000

Other practice location 3

2050 W Southern Ave
Apache Junction, AZ 85120-7305
Phone (480) 733-3300

Other practice location 4

17900 N Porter Rd
Maricopa, AZ 85138-4228
Phone (520) 233-2500

Other practice location 5

1811 E McMurray Blvd
Casa Grande, AZ 85122-5404
Phone (520) 374-6530

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111228000353 AZ Part B Supplier - Clinic/Group Practice 7911173794 Receives reassigned benefits from 207 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Buckeye, AZ; Sun City West, AZ; Scottsdale, AZ; San Tan Valley, AZ; Queen Creek, AZ; Phoenix, AZ; Mesa, AZ; Maricopa, AZ…

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Tiffany Weathers

Locations

1432 S Dobson Rd
Ste 209
Mesa, AZ 85202
Phone (480) 412-6970

1432 S Dobson Rd
Ste 512
Mesa, AZ 85202
Phone (480) 412-6336

37100 N Gantzel Rd
Ste 214
San Tan Valley, AZ 85140
Phone (480) 321-8267

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1324252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776297600000",
    "number": "1396014403",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37100 N GANTZEL RD STE 214",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851407353",
            "telephone_number": "480-412-9400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1760 E Florence Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Casa Grande",
            "state": "AZ",
            "postal_code": "851224765",
            "country_code": "US",
            "telephone_number": "520-374-6505",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "37000 N Gantzel Rd",
            "address_purpose": "LOCATION",
            "city": "Queen Creek",
            "state": "AZ",
            "postal_code": "851407303",
            "country_code": "US",
            "telephone_number": "480-397-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2050 W Southern Ave",
            "address_purpose": "LOCATION",
            "city": "Apache Junction",
            "state": "AZ",
            "postal_code": "851207305",
            "country_code": "US",
            "telephone_number": "480-733-3300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17900 N Porter Rd",
            "address_purpose": "LOCATION",
            "city": "Maricopa",
            "state": "AZ",
            "postal_code": "851384228",
            "country_code": "US",
            "telephone_number": "520-233-2500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1811 E McMurray Blvd",
            "address_purpose": "LOCATION",
            "city": "Casa Grande",
            "state": "AZ",
            "postal_code": "851225404",
            "country_code": "US",
            "telephone_number": "520-374-6530",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER MEDICAL GROUP",
        "enumeration_date": "2011-12-19",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A",
        "authorized_official_last_name": "BIRDI",
        "authorized_official_first_name": "SHIVA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Tan Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2026; 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.