Organization Active NPI

Thoracic Cardiovascular Associates LTD

  • Specialist
  • Phoenix, AZ
National Provider Identifier
1437266244
Registry record updated Nov 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
1008 Issued in AZ
Legal business name
THORACIC CARDIOVASCULAR ASSOCIATES LTD
Practice address
16601 N 40TH St Ste 226
Phoenix, AZ 85032-3354
Phone
(602) 264-7741
Fax
(602) 277-7402
NPI assigned
Aug 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2022

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

Authorized official

Name
Mr. Clark Benham
Title
Business Administrator
Phone
(602) 264-7741

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 1008 AZ Primary

Addresses

Primary practice location

16601 N 40TH St Ste 226
Phoenix, AZ 85032-3354

Mailing address

16601 N 40TH St Ste 226
Phoenix, AZ 85032-3354
Phone (602) 264-7741

Other identifiers 1

IdentifierTypeStateIssuer
22763801MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040624001497 AZ Part B Supplier - Clinic/Group Practice 9638155369 Receives reassigned benefits from 1 practitioner
Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory

Locations

16601 N 40th St
Ste 226
Phoenix, AZ 85032
Phone (602) 264-7741

Practitioners & affiliated clinicians

Practitioners 2

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": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667952000000",
    "number": "1437266244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16601 N 40TH ST STE 226",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850323354",
            "telephone_number": "602-264-7741",
            "fax_number": "602-277-7402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16601 N 40TH ST STE 226",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850323354",
            "telephone_number": "602-264-7741",
            "fax_number": "602-277-7402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THORACIC CARDIOVASCULAR ASSOCIATES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A",
        "authorized_official_last_name": "BENHAM",
        "authorized_official_first_name": "CLARK",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "602-264-7741",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AZ",
            "license": "1008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "22763801",
            "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 Nov 9, 2022; 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.