Ajith Purush MD PLC
Organization Active NPI Internal Medicine Physician · Prescott, AZ
NPI 1487967519 · NPPES record last updated Nov 16, 2020
Key facts
- NPI
- 1487967519
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 33680 (AZ)
- Legal business name
- AJITH PURUSH MD PLC
- Practice address
- 722 N Montezuma St
Prescott, AZ 86301-2002 - Phone
- (928) 237-9000
- Fax
- (928) 237-9011
- NPI assigned
- Jul 18, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Ajith Purush, MD
- Title
- Member
- Phone
- (928) 710-1533
Practitioners 5
-
Ajith Purush, MBBS, MD
-
Patricia Miriam Rus, PA-C
-
Tess Barnes, N.P.
-
Virginia I Greene, FNP
-
Erin Langmead, PA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2028539 | Apurva Advanced Medical Care | Certificate of waiver | Aug 17, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101105000110 | AZ | Part B Supplier - Clinic/Group Practice | 0941494785 |
Receives reassigned benefits from 5 practitioners Practice locations: Prescott, AZ |
National Provider Directory
Locations
1958 Commerce Center Cir
Prescott, AZ 86301
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 33680 | AZ | Yes |
| In Home Supportive Care Agency | 253Z00000X | |||
| Multi-Specialty Clinic/Center | 261QM1300X |
Addresses
Primary practice location
722 N Montezuma St
Prescott, AZ 86301-2002
Mailing address
722 N Montezuma St
Prescott, AZ 86301-2002
Phone (928) 237-9000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00217872 | Other | AZ | RR MEDICARE |
Other names
- Apurva Advanced Medical Care
Other providers in Prescott, AZ
- Ageless Living Institute LLC
- Ayad K Agha
- Jeffrey Alexander Aguiar
- Andrew Agullard
- Stephen Aiello
- Akdhc, LLC
- Akdhc, LLC
- Pamela Ann Akers
- Patricia J Akovenko
- Alaga Health Chronic Care Management LLC
All providers in Prescott, AZ · Internal Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.