NPIMap

Organization Active NPI

Spectrum Medical Care Center

  • Medical Specialty Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1417433236
Registry record updated Sep 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
24745 Issued in AZ
Legal business name
SPECTRUM MEDICAL CARE CENTER
Practice address
52 E Monterey Way Ste a
Phoenix, AZ 85012-2628
Phone
(480) 930-4353
Fax
(480) 930-4353
NPI assigned
Jul 15, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2026

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

Authorized official

Name
Efram J Peller
Title
Coo
Phone
(602) 604-9500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 24745 AZ Primary

Addresses

Primary practice location

52 E Monterey Way Ste a
Phoenix, AZ 85012-2628

Mailing address

52 E Monterey Way Ste a
Phoenix, AZ 85012-2628
Phone (602) 604-9500

Other identifiers 3

IdentifierTypeStateIssuer
24745OtherAZAZ LICENSE
382763MedicaidAZ
AZ0800990OtherAZBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201118000539 AZ Part B Supplier - Clinic/Group Practice 9739590076 Receives reassigned benefits from 10 practitioners
Practice locations: Phoenix, AZ

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2152764Spectrum Medical Care Center52 E Monterey Way, Phoenix, AZ 85012Certificate of waiverAug 15, 2026

National Provider Directory

National Provider Directory

Locations

52 E Monterey Way
Ste A
Phoenix, AZ 85012
Phone (480) 930-4353

52 E Monterey Way
Phoenix, AZ 85012
Phone (602) 264-7273

4350 N 19th Ave
Phoenix, AZ 85015
Phone (602) 264-9191

Practitioners & affiliated clinicians

Practitioners 12

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": "1531612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788480000000",
    "number": "1417433236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 E MONTEREY WAY STE A",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122628",
            "telephone_number": "602-604-9500",
            "fax_number": "480-930-4353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 E MONTEREY WAY STE A",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122628",
            "telephone_number": "480-930-4353",
            "fax_number": "480-930-4353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM MEDICAL CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-15",
        "last_updated": "2026-09-04",
        "certification_date": "2026-09-04",
        "status": "A",
        "authorized_official_last_name": "PELLER",
        "authorized_official_first_name": "EFRAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "602-604-9500"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "AZ",
            "license": "24745",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ LICENSE",
            "identifier": "24745",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "382763",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "AZ0800990",
            "state": "AZ"
        }
    ],
    "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 Sep 4, 2026; 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.