Organization Active NPI

Keystone Medical, PLLC

  • Internal Medicine Physician
  • Tucson, AZ
National Provider Identifier
1477975647
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
32180 Issued in AZ
Legal business name
KEYSTONE MEDICAL, PLLC
Practice address
6211 N la Cholla Blvd
Tucson, AZ 85741-3528
Phone
(520) 575-0900
Fax
(520) 547-2382
NPI assigned
Jan 7, 2014
Last updated
Feb 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

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

Authorized official

Name
Rebecca Pradhan-Nara, MD
Title
Sole Member
Phone
(520) 266-4338

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 32180 AZ Primary
Assisted Living Facility 310400000X 32180 AZ
Skilled Nursing Facility 314000000X 32180 AZ

Addresses

Primary practice location

6211 N la Cholla Blvd
Tucson, AZ 85741-3528

Mailing address

PO Box 43100
Tucson, AZ 85733-3100
Phone (520) 722-3777

Other identifiers 1

IdentifierTypeStateIssuer
897280MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140512001434 AZ Part B Supplier - Clinic/Group Practice 9739312075 Receives reassigned benefits from 4 practitioners
Practice locations: Tucson, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1389052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739232000000",
    "number": "1477975647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43100",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857333100",
            "telephone_number": "520-722-3777",
            "fax_number": "520-547-2382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6211 N LA CHOLLA BLVD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857413528",
            "telephone_number": "520-575-0900",
            "fax_number": "520-547-2382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-07",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A",
        "authorized_official_last_name": "PRADHAN-NARA",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "520-266-4338",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "32180",
            "primary": true
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "32180",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "32180",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "897280",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; 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.