Agave Surgical Services LLC

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

Legal business name

AGAVE SURGICAL SERVICES LLC

Practice address

2045 S Vineyard Ste 142
Mesa, AZ 85210-6891

Phone

(480) 330-6010

NPI assigned

Jan 8, 2019

Last updated

Jan 8, 2019By 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

Bernadette Andalkar, ACNP-BCNPI 1851681498

Title

Owner

Phone

(520) 490-8368

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Practitioners 1

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.

• Bernadette Marie Andalkar, ACNP-BC

  • Nurse Practitioner
  • Mesa, AZ
  • NPI 1851681498

  Acute Care

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1546905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546905600000",
    "number": "1477026862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 S VINEYARD STE 142",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106891",
            "telephone_number": "480-330-6010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 S VINEYARD STE 142",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106891",
            "telephone_number": "480-330-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAVE SURGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-08",
        "last_updated": "2019-01-08",
        "status": "A",
        "authorized_official_last_name": "ANDALKAR",
        "authorized_official_first_name": "BERNADETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "520-490-8368",
        "authorized_official_credential": "ACNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Agh Mesa LLC (Dignity Health Arizona General Hospital Emergency Room - Mesa)
• Agh Mesa LLC (Dignity Health Arizona General Hospital)

• Acute Care Nurse Practitioner in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Acute Care Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; 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.