Individual provider Active NPI

Edward R Flamand, PT

  • Physical Therapist
  • Wickenburg, AZ
National Provider Identifier
1477829174
Registry record updated Aug 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
9487 Issued in AZ
Practice address
1175 W Wickenburg Way Ste 3
Wickenburg, AZ 85390-2262
Phone
(928) 668-0108
Fax
(928) 668-0110
NPI assigned
Mar 27, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 9487 AZ Primary

Addresses

Primary practice location

1175 W Wickenburg Way Ste 3
Wickenburg, AZ 85390-2262

Mailing address

1175 W Wickenburg Way Ste 3
Wickenburg, AZ 85390-2262
Phone (928) 668-0108

Other identifiers 3

IdentifierTypeStateIssuer
104774MedicaidAZ
P01623030OtherAZRAILROAD MEDICARE
Z1186507OtherAZMEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160301001164 AZ Practitioner - Physical Therapist in Private Practice 0547565459 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Champion Physical Therapy LLCGroup PAC ID 4880783729, 4 clinicians

Practice addresses (Care Compare)

1175 W Wickenburg Way
Suite 3
Wickenburg, AZ 85390-2262
Phone (928) 668-0108

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9487AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Champion Physical Therapy LLC CurrentSince Feb 22, 2016 Accepting new patients
Northwest Orthopedic & Sports Physical Therapy LLC PastSince Jul 24, 2022 Accepting new patients

Locations

2000 W Wickenburg Way
Ste 200
Wickenburg, AZ 85390
Phone (928) 668-0108

1175 W Wickenburg Way
Ste 3
Wickenburg, AZ 85390
Phone (928) 668-0108

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1332806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659744000000",
    "number": "1477829174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 W WICKENBURG WAY STE 3",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "853902262",
            "telephone_number": "928-668-0108",
            "fax_number": "928-668-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 W WICKENBURG WAY STE 3",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "853902262",
            "telephone_number": "928-668-0108",
            "fax_number": "928-668-0110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLAMAND",
        "first_name": "EDWARD",
        "middle_name": "R",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-27",
        "last_updated": "2022-08-06",
        "certification_date": "2022-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "9487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104774",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01623030",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z1186507",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wickenburg, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2022; 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.