NPIMap

Organization Active NPI

Ellsworth Medical Group LLC

  • General Practice Physician
  • Queen Creek, AZ
National Provider Identifier
1467928804
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
ELLSWORTH MEDICAL GROUP LLC
Practice address
21323 S Ellsworth Loop Rd Ste 101
Queen Creek, AZ 85142-9865
Phone
(480) 307-8440
NPI assigned
Oct 23, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

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

Authorized official

Name
Radman RahiminejadNPI 1821040775
Title
Owner
Phone
(480) 926-7800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

21323 S Ellsworth Loop Rd Ste 101
Queen Creek, AZ 85142-9865

Mailing address

PO Box 6610
Chandler, AZ 85246-6610
Phone (480) 926-7800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181215000576 AZ Part B Supplier - Clinic/Group Practice 4082959267 Receives reassigned benefits from 7 practitioners
Practice locations: Queen Creek, AZ
O20210209002607 AZ DME Supplier - Medical Supply Company 4082959267 Practice locations: Queen Creek, AZ

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Ellsworth Medical Group LLC21323 S Ellsworth Loop Rd, Queen Creek, AZ 85142-9865(480) 307-8440 Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf Accepts assignmentParticipating since Nov 2, 2018

National Provider Directory

National Provider Directory

Locations

21323 S Ellsworth Loop Rd
Ste 10
Queen Creek, AZ 85142

21323 S Ellsworth Loop Rd
Queen Creek, AZ 85142

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1467928804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6610",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852466610",
            "telephone_number": "480-926-7800",
            "fax_number": "480-926-2260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21323 S ELLSWORTH LOOP RD STE 101",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851429865",
            "telephone_number": "480-307-8440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLSWORTH MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-23",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "RAHIMINEJAD",
        "authorized_official_first_name": "RADMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-926-7800"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Queen Creek, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; 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.