Agh Laveen LLC
Organization Active NPI Emergency Care Clinic/Center · Phoenix, AZ
NPI 1447700968 · NPPES record last updated Mar 24, 2020
Key facts
- NPI
- 1447700968
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Care Clinic/Center 261QE0002X
- License
- H6937 (AZ)
- Legal business name
- AGH LAVEEN LLC
- Practice address
- 4328 E Chandler Blvd
Phoenix, AZ 85048-8839 - Phone
- (480) 454-3630
- NPI assigned
- Oct 7, 2016
- Organization subpart
- No
Authorized official
- Name
- Jane Hanson
- Title
- Ceo
- Phone
- (480) 410-4523
Owners & managing parties with NPI records 11
-
Aaron Mickelson, D.O.
Other NPIs on the same Medicare enrollment 11
Affiliated clinicians 123
-
Ahmed Al Dulaimi, MD
-
Hossam Alhabach, M.D.
-
Scott Babb, MD
-
David Q. Bell, M.D.
-
Thomas Michael Bell, D.O.
-
David John Bennett, D.O
-
Shane M Bezzant, M.D.
-
James N. Bogert, MD
-
Sean Logan Boone, MD
-
James Willis Buckner II, M.D.
-
Nancy Churosh, M.D.
-
Paul Crawford, MD
-
Sumit Dewanjee, M.D.
-
Ali Adam Dosani, MD
-
Kyle Durfey, DPM
-
Nana N Dwomoh, DO
Medicare Care Compare: Hospital
- Listed as
- Dignity Health - Arizona General Hospital
- Type
- Acute Care Hospitals
- Ownership
- Proprietary
- Medicare certification status
- Active
- Emergency services
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Hospital certification: CCN 030136
- Legal name
- AGH LAVEEN LLC
- Doing business as
- DIGNITY HEALTH ARIZONA GENERAL HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jan 30, 2015
- Last certification
- Oct 9, 2019
- Beds
- 16
- Ownership / control type
- Private (for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 1, 2014 in AZ
- Enrollment address
- 7171 S 51St Ave
Laveen, AZ 85339-2923 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Aaron J Mickelson |
Corporate Officer |
May 1, 2022 | |
| W-2 Managing Employee |
May 1, 2022 | ||
| Agh Phoenix LLC |
5% Or Greater Direct Ownership Interest | Dec 1, 2014 | 100% |
| Eric T Sorensen |
Corporate Director |
Nov 1, 2021 | |
| Jeffrey Thomas O'Malley |
Corporate Director |
Mar 1, 2020 | |
| Commonspirit Health |
5% Or Greater Indirect Ownership Interest | Feb 1, 2019 | 100% |
| Operational/Managerial Control | Feb 1, 2019 | 100% | |
| Dignity Health |
Other | Feb 1, 2019 | |
| Peggy Sanborn |
Corporate Director |
Aug 22, 2018 | |
| Daniel Morissette |
Corporate Officer |
Feb 1, 2019 | |
| Other |
Sep 1, 2023 | ||
| Derek Havens |
Corporate Director |
May 1, 2022 | |
| Steven W Scharmann |
Corporate Officer |
Feb 1, 2019 | |
| John E Petersdorf |
Corporate Officer |
Feb 1, 2019 | |
| Larissa Spraker |
Corporate Director |
Nov 1, 2021 | |
| John Bauer |
Corporate Officer |
Nov 4, 2019 | |
| W-2 Managing Employee |
Nov 4, 2019 | ||
| Dignity Community Care |
5% Or Greater Indirect Ownership Interest | Feb 1, 2019 | 100% |
| Bradley Pristelski |
Corporate Director |
Mar 1, 2020 | |
| Jane Hanson |
Corporate Officer |
Jul 30, 2018 | |
| W-2 Managing Employee |
Jul 30, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140912001647 | AZ | Part a Provider - Hospital | 4789803370 |
11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Glendale, AZ; Goodyear, AZ; Laveen, AZ; Surprise, AZ |
National Provider Directory
Locations
2977 E Germann Rd
Chandler, AZ 85286
Phone (480) 732-7540
4760 E Germann Rd
Gilbert, AZ 85297
Phone (480) 494-5000
14267 W Bell Rd
Surprise, AZ 85374
Phone (623) 546-5230
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Care Clinic/Center | 261QE0002X | H6937 | AZ | Yes |
Addresses
Primary practice location
4328 E Chandler Blvd
Phoenix, AZ 85048-8839
Mailing address
3030 N Central Ave Ste 1402
Phoenix, AZ 85012-2720
Phone (602) 406-3306
Other names
- Dignity Health Arizona General Hospital Emergency Room
Other providers in Phoenix, AZ
- Jacqueline Lea Agenbroad
- Michelle Elaine Ageno
- Gaurav Aggarwal
- Gautam Aggarwal
- Sourabh Aggarwal
- Agh Laveen LLC
- Agh Mesa LLC
- Ahmed K Agha
- Apeldin Aghassi
- Mustafa Agil
All providers in Phoenix, AZ · Emergency Care Clinic/Center in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.