NPIMap

Organization Active NPI

Northeastern Anesthesia PLLC

  • Anesthesiology Physician
  • Sierra Vista, AZ
National Provider Identifier
1487956504
Registry record updated Oct 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
NORTHEASTERN ANESTHESIA PLLC
Practice address
5700 E Highway 90
Sierra Vista, AZ 85635-9110
Phone
(520) 263-3835
Fax
(520) 263-3919
NPI assigned
Nov 22, 2010
Last updated
Oct 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2026

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

Authorized official

Name
Joseph William Martin, CRNANPI 1003239336
Title
Owner
Phone
(559) 289-4574

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

5700 E Highway 90
Sierra Vista, AZ 85635-9110

Mailing address

PO Box 849955
Los Angeles, CA 90084-9955
Phone (877) 747-5050

Other practice location 1

101 Civic Center Ln
Lake Havasu City, AZ 86403-5607
Phone (928) 855-8185

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/ Other Management Services Network, LLC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110126001051 AZ Part B Supplier - Clinic/Group Practice 4284813940 Receives reassigned benefits from 133 practitioners
Practice locations: Sierra Vista, AZ; Show Low, AZ; Lakeside, AZ; Payson, AZ; Fort Mohave, AZ; Lake Havasu City, AZ

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4830 Highway 260
Lakeside, AZ 85929
Phone (928) 537-8777

2650 E Show Low Lake Rd
Ste 2
Show Low, AZ 85901
Phone (928) 532-3008

4951 S White Mountain Rd
Ste B
Show Low, AZ 85901
Phone (928) 537-4375

Practitioners & affiliated clinicians

Practitioners 136

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.

View all 136

NPI Registry JSON

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

{
    "created_epoch": "1290384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792195200000",
    "number": "1487956504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 849955",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900849955",
            "telephone_number": "877-747-5050",
            "fax_number": "775-747-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 E HIGHWAY 90",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856359110",
            "telephone_number": "520-263-3835",
            "fax_number": "520-263-3919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Civic Center Ln",
            "address_purpose": "LOCATION",
            "city": "Lake Havasu City",
            "state": "AZ",
            "postal_code": "864035607",
            "country_code": "US",
            "telephone_number": "928-855-8185",
            "fax_number": "928-453-0453",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHEASTERN ANESTHESIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-22",
        "last_updated": "2026-10-17",
        "certification_date": "2026-10-17",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "559-289-4574",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.1036.1",
            "affiliationName": "Management Services Network, LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2357 Warm Springs RD Ste 400",
            "city": "Columbus",
            "state": "GA",
            "country_code": "US",
            "postal_code": "319046874",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sierra Vista, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2026; 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.