Active NPI
Nicole Bacha
- Student in an Organized Health Care Education/Training Program
- Phoenix, AZ
National Provider Identifier
1467203992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- R82369
- Practice address
- 1300 N 12TH St Ste 508
Phoenix, AZ 85006-2849 - Phone
- (602) 839-3927
- NPI assigned
- Apr 1, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | R82369 | AZ | Primary |
Addresses
Primary practice location
1300 N 12TH St Ste 508
Phoenix, AZ 85006-2849
Mailing address
1111 E McDowell Rd
Phoenix, AZ 85006-2612
Phone (602) 839-3927
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260624000818 | AZ | Order and Referring Only - Internal Medicine | 0345713178 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R82369 | AZ | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778544000000",
"number": "1467203992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 E MCDOWELL RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062612",
"telephone_number": "602-839-3927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 N 12TH ST STE 508",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062849",
"telephone_number": "602-839-3927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACHA",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-01",
"last_updated": "2026-05-12",
"certification_date": "2026-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "AZ",
"license": "R82369",
"primary": true
}
],
"identifiers": [],
"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 May 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.