Active NPI
Philip Perera
- Psychiatry Physician
- San Tan Valley, AZ
National Provider Identifier
1487396156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 17183
- Practice address
- 30883 N Glory GRV
San Tan Valley, AZ 85143-3124 - Phone
- (858) 504-0916
- NPI assigned
- Apr 12, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 17183 | NY | Primary |
Addresses
Primary practice location
30883 N Glory GRV
San Tan Valley, AZ 85143-3124
Mailing address
30883 N Glory GRV
San Tan Valley, AZ 85143-3124
Phone (858) 504-0916
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17183 | NY | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649721600000",
"number": "1487396156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30883 N GLORY GRV",
"city": "SAN TAN VALLEY",
"state": "AZ",
"postal_code": "851433124",
"telephone_number": "858-504-0916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30883 N GLORY GRV",
"city": "SAN TAN VALLEY",
"state": "AZ",
"postal_code": "851433124",
"telephone_number": "858-504-0916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERERA",
"first_name": "PHILIP",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-12",
"last_updated": "2022-04-12",
"certification_date": "2022-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "17183",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Tan Valley, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.