Active NPI
Atlas Medical Aco LLC
- Clinic/Center
- Mesa, AZ
National Provider Identifier
1396573705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- ATLAS MEDICAL ACO LLC
- Practice address
- 7227 E Baseline Rd Ste 126
Mesa, AZ 85209-5006 - Phone
- (480) 219-4790
- NPI assigned
- Jul 25, 2024
- Organization subpart
- Yes
- Parent organization
- ATLAS MEDICAL ACO LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gregory Chad Mangum
- Title
- Owner
- Phone
- (435) 514-5646
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
7227 E Baseline Rd Ste 126
Mesa, AZ 85209-5006
Mailing address
PO Box 4682
Logan, UT 84323-4682
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250416003928 | AZ | Part B Supplier - Clinic/Group Practice | 1456885227 |
Receives reassigned benefits from 48 practitioners Practice locations: Mesa, AZ |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Part of
- Atlas Medical Aco LLC
Locations
3831 E Blue Lupine Dr
Ste C
Wasilla, AK 99654
Phone (907) 215-4846
Practitioners & affiliated clinicians
Practitioners 56
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721865600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1729123200000",
"number": "1396573705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4682",
"city": "LOGAN",
"state": "UT",
"postal_code": "843234682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7227 E BASELINE RD STE 126",
"city": "MESA",
"state": "AZ",
"postal_code": "852095006",
"telephone_number": "480-219-4790"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ATLAS MEDICAL ACO LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ATLAS MEDICAL ACO LLC",
"enumeration_date": "2024-07-25",
"last_updated": "2024-10-17",
"certification_date": "2024-10-17",
"status": "A",
"authorized_official_last_name": "MANGUM",
"authorized_official_first_name": "GREGORY",
"authorized_official_middle_name": "CHAD",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "435-514-5646"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"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 17, 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.