Active NPI
Agave Surgical Services LLC
- Acute Care Nurse Practitioner
- Mesa, AZ
National Provider Identifier
1477026862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- 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
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Bernadette Andalkar, ACNP-BC
- Title
- Owner
- Phone
- (520) 490-8368
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | Primary |
Addresses
Primary practice location
2045 S Vineyard Ste 142
Mesa, AZ 85210-6891
Mailing address
2045 S Vineyard Ste 142
Mesa, AZ 85210-6891
Phone (480) 330-6010
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190208003120 | AZ | Part B Supplier - Clinic/Group Practice | 5991043374 |
Receives reassigned benefits from 1 practitioner Practice locations: Mesa, AZ |
National Provider Directory
National Provider DirectoryLocations
2045 S Vineyard
Ste 142
Mesa, AZ 85210
Phone (480) 330-6010
NPI Registry JSON
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": []
}Other providers in Mesa, AZ
Sources for this page
- 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.