NPIMap

Organization Active NPI

Sun Life Family Health Center, Inc.

Doing business as Sun Life Family Health Center

  • Federally Qualified Health Center (FQHC)
  • San Manuel, AZ
National Provider Identifier
1467666206
Registry record updated Aug 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OTC-357 Issued in AZ
Legal business name
SUN LIFE FAMILY HEALTH CENTER, INC.
Doing business as
Sun Life Family Health Center
Practice address
23 S McNab Pkwy
San Manuel, AZ 85631-1156
Phone
(520) 385-2234
Fax
(520) 381-3209
NPI assigned
May 10, 2007
Last updated
Aug 3, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2017

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

Authorized official

Name
Travis Robinette
Title
Ceo
Phone
(520) 836-3446

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X OTC-357 AZ Primary

Addresses

Primary practice location

23 S McNab Pkwy
San Manuel, AZ 85631-1156

Mailing address

PO Box 10097
Casa Grande, AZ 85130-0020
Phone (520) 836-3446

Other identifiers 2

IdentifierTypeStateIssuer
AZ04943MedicaidAZ
ZFQ61788OtherMEDICARE

Other names 1

  • Sun Life Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205000085 AZ Part B Supplier - Clinic/Group Practice 9335032275 Receives reassigned benefits from 85 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Maricopa, AZ; Oracle, AZ; Mesa, AZ; Florence, AZ; Eloy, AZ; Chandler, AZ; Casa Grande, AZ; Coolidge, AZ

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory

Member of 1

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

Locations

205 N Stuart Blvd
Eloy, AZ 85131
Phone (520) 466-7883

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501718400000",
    "number": "1467666206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10097",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851300020",
            "telephone_number": "520-836-3446",
            "fax_number": "520-836-8807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 S MCNAB PKWY",
            "city": "SAN MANUEL",
            "state": "AZ",
            "postal_code": "856311156",
            "telephone_number": "520-385-2234",
            "fax_number": "520-381-3209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN LIFE FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2017-08-03",
        "status": "A",
        "authorized_official_last_name": "ROBINETTE",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-836-3446"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OTC-357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AZ04943",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "ZFQ61788",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sun Life Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Manuel, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2017; 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.