East Southern Medical Group, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

EAST SOUTHERN MEDICAL GROUP, LLC

Practice address

5233 E Southern Ave Ste 103
Mesa, AZ 85206-3628

Phone

(480) 830-2882

Fax

(480) 830-2881

NPI assigned

Mar 11, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Derek P Pruni, DCNPI 1154304590

Title

Owner

Phone

(480) 830-2882

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ2 enrollments

Enrollment records 2

Locations

Practitioners 3

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

• Derek P Pruni, DC

  • Chiropractor
  • Mesa, AZ
  • NPI 1154304590
  Medicare reassignment Care Compare group NPD Authorized official
• Mark A Zitnik, DC

  • Rehabilitation Chiropractor
  • Mesa, AZ
  • NPI 1598836264
  Medicare reassignment Care Compare group NPD
• Lynaia Hoogewerf, P.A.-C

  • Medical Physician Assistant
  • Mesa, AZ
  • NPI 1891829909
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682985600000",
    "number": "1477011237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5233 E SOUTHERN AVE STE 103",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063628",
            "telephone_number": "480-830-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5233 E SOUTHERN AVE STE 103",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063628",
            "telephone_number": "480-830-2882",
            "fax_number": "480-830-2881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST SOUTHERN MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-11",
        "last_updated": "2023-05-02",
        "certification_date": "2023-05-02",
        "status": "A",
        "authorized_official_last_name": "PRUNI",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-830-2882",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• East Mesa Physical Therapy and Rehab Specialists
• East Valley Adult Resources
• East Valley ASC LLC
• East Valley Bone and Joint PLLC
• East Valley Center for Pulmonary & Sleep Disorders Inc
• East Valley Child Psychology

• Physical Medicine & Rehabilitation Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Physical Medicine & Rehabilitation Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2023; 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.