Banner Enticare Tempe Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

BANNER ENTICARE TEMPE SURGERY CENTER LLC

Doing business as

Banner Tempe Surgery Center

Practice address

1940 E Southern Ave
Tempe, AZ 85282-7518

Phone

(480) 820-7101

NPI assigned

Feb 20, 2019

Last updated

Feb 11, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Homan Mostafavi, DO

Title

Manager-Member

Phone

(248) 229-6188

Specialties & licenses 1

Addresses

Other names 1

• Banner Tempe Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Listed as

Banner Enticare Tempe Surgery Center LLC Dba Banner Tempe Surgery CenterCCN 03C0001406

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Enticare PC

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Chandler, AZ
  • NPI 1710014410

  Member Of

  NPD member
• Banner Health

  dba Banner Hospice of Northern Colorado

  • Community Based Hospice Care Agency
  • Greeley, CO
  • NPI 1407409964

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1550620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581379200000",
    "number": "1437615929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 E CAMELBACK RD STE 700",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850169044",
            "telephone_number": "602-550-0428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1940 E SOUTHERN AVE",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827518",
            "telephone_number": "480-820-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER ENTICARE TEMPE SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-20",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A",
        "authorized_official_last_name": "MOSTAFAVI",
        "authorized_official_first_name": "HOMAN",
        "authorized_official_title_or_position": "MANAGER-MEMBER",
        "authorized_official_telephone_number": "248-229-6188",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Banner Tempe Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Banner Tempe Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jordan Ball
• John Balles, PH.D.
• Willie Benjamin Ballou, NP-C
• Blythe Bankenbush, PA-C
• Carrie Susanne Bann, PMHNP-BC
• Banner Health (Banner Health Clinic- Tempe)
• Banner Occupational Health - Onsite, LLC
• Banner Urgent Care Services, LLC
• Banner Urgent Care Services, LLC
• Banner Urgent Care Services, LLC

• Ambulatory Surgical Clinic/Center in Tempe, AZ
• Providers in Tempe, AZ by specialty
• Ambulatory Surgical Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2020; 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.