Panacea Brain and Spine, LLC

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

46605 Issued in AZ

Legal business name

PANACEA BRAIN AND SPINE, LLC

Practice address

72 Lake Havasu Ave S Ste 102
Lake Havasu City, AZ 86403-0857

Phone

(928) 453-2211

Fax

(928) 453-2213

NPI assigned

Jan 18, 2012

Last updated

Jun 29, 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. Chad Hartley, MDNPI 1457513749

Title

Owner

Phone

(720) 883-1593

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ2 enrollments

Enrollment records 2

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

CLIA laboratory certificates

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Panacea Brain and Spine, LLC

  • Non-Pharmacy Dispensing Site
  • Lake Havasu City, AZ
  • NPI 1154765121
  NPPES parent name

Practitioners 3

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.

• Chad Edward Hartley, MD

  • Neurological Surgery Physician
  • Lake Havasu City, AZ
  • NPI 1457513749
  Medicare reassignment Care Compare group Authorized official
• Marc Duane Christensen, MD, PHD, PA

  • Neurological Surgery Physician
  • Lake Havasu City, AZ
  • NPI 1396747218
  Medicare reassignment Care Compare group NPD
• John E Lankenau, M.D.

  • Orthopaedic Surgery Physician
  • Lake Havasu City, AZ
  • NPI 1275561425
  Medicare reassignment NPD

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

{
    "created_epoch": "1326844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593388800000",
    "number": "1457622763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 LAKE HAVASU AVE S STE 102",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864030857",
            "telephone_number": "928-453-2211",
            "fax_number": "928-453-2219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 LAKE HAVASU AVE S STE 102",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864030857",
            "telephone_number": "928-453-2211",
            "fax_number": "928-453-2213"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 W Mohave Rd",
            "address_purpose": "LOCATION",
            "city": "Parker",
            "state": "AZ",
            "postal_code": "853446349",
            "country_code": "US",
            "telephone_number": "928-453-2211",
            "fax_number": "928-453-2219",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13677 W McDowell Rd",
            "address_purpose": "LOCATION",
            "city": "Goodyear",
            "state": "AZ",
            "postal_code": "853952635",
            "country_code": "US",
            "telephone_number": "928-453-2211",
            "fax_number": "928-453-2219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PANACEA BRAIN AND SPINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-18",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A",
        "authorized_official_last_name": "HARTLEY",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-883-1593",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "AZ",
            "license": "46605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vic S Oyas, M.D.
• Elizabeth Rorie Page, PT
• Donna Pakula, LAB DIRECTOR
• Pamela Reband MD PC
• Panacea Brain and Spine, LLC
• Linda Louise Paquette, MS, LISAC
• Elizabeth M Parchoc, LCSW
• Park Place Declarant (Fabulous Hearing)
• Parker Dental
• Kaitlyn Rose Patacca, MD

• Neurological Surgery Physician in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Neurological Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 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.