NPIMap

Organization Active NPI

DHHS IHS Phoenix Area

  • Family Medicine Physician
  • San Carlos, AZ
National Provider Identifier
1487906418
Registry record updated Oct 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DHHS IHS PHOENIX AREA
Practice address
223 Cibecue Circle Road
San Carlos, AZ 85550-0208
Phone
(928) 475-7285
NPI assigned
Oct 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2012

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

Authorized official

Name
Mrs. Shirley M Boni
Title
Administrative Officer
Phone
(928) 475-7348

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

223 Cibecue Circle Road
San Carlos, AZ 85550-0208

Mailing address

PO Box 208
San Carlos, AZ 85550-0208
Phone (928) 475-7285

Other names 1

  • San Carlos Indian Hospital Doing business as

National Provider Directory

National Provider Directory
Tax ID family
DHHS IHS Phoenix Area5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350259200000",
    "number": "1487906418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 208",
            "city": "SAN CARLOS",
            "state": "AZ",
            "postal_code": "855500208",
            "telephone_number": "928-475-7285",
            "fax_number": "928-475-7371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 CIBECUE CIRCLE ROAD",
            "city": "SAN CARLOS",
            "state": "AZ",
            "postal_code": "855500208",
            "telephone_number": "928-475-7285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DHHS IHS PHOENIX AREA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-15",
        "last_updated": "2012-10-15",
        "status": "A",
        "authorized_official_last_name": "BONI",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "928-475-7348",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Carlos Indian Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Carlos, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.