NPIMap

Organization Active NPI

Puerto Sonora Internal Medicine

  • Internal Medicine Physician
  • Tempe, AZ
National Provider Identifier
1427635408
Registry record updated Feb 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PUERTO SONORA INTERNAL MEDICINE
Practice address
4653 S Lakeshore Dr Ste 3
Tempe, AZ 85282-7161
Phone
(480) 456-8981
Fax
(480) 456-2906
NPI assigned
Mar 25, 2021
Last updated
Feb 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2023

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

Authorized official

Name
Lynn Pangallo
Title
Accounting Manager - Credentialing
Phone
(702) 375-5777

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) Physician 207QA0401X NU
Adult Medicine Physician 207QA0505X NU
Internal Medicine Physician 207R00000X NU Primary
Pain Medicine Physician 208VP0000X NU

Addresses

Primary practice location

4653 S Lakeshore Dr Ste 3
Tempe, AZ 85282-7161

Mailing address

4653 S Lakeshore Dr Ste 3
Tempe, AZ 85282-7161
Phone (480) 456-8981

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230202001988 AZ Part B Supplier - Clinic/Group Practice 6002288958 Receives reassigned benefits from 8 practitioners
Practice locations: Tempe, AZ; Scottsdale, AZ; Phoenix, AZ; Glendale, AZ

National Provider Directory

National Provider Directory

Locations

18205 N 51st Ave
Ste 123
Glendale, AZ 85308
Phone (623) 398-8554

4643 N 12th St
Ste 101
Phoenix, AZ 85014
Phone (602) 641-4263

4653 S Lakeshore Dr
Ste 3
Tempe, AZ 85282
Phone (480) 456-8981

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1616630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677542400000",
    "number": "1427635408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4653 S LAKESHORE DR STE 3",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827161",
            "telephone_number": "480-456-8981",
            "fax_number": "480-456-2906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4653 S LAKESHORE DR STE 3",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827161",
            "telephone_number": "480-456-8981",
            "fax_number": "480-456-2906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUERTO SONORA INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-25",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A",
        "authorized_official_last_name": "PANGALLO",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "ACCOUNTING MANAGER - CREDENTIALING",
        "authorized_official_telephone_number": "702-375-5777"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; 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.