NPIMap

Organization Active NPI

Circle the City

Doing business as Circle the City Family Health Center, After Hours Clinic - LDRC

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
National Provider Identifier
1497260426
Registry record updated Dec 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CIRCLE THE CITY
Doing business as
Circle the City Family Health Center, After Hours Clinic - LDRC
Practice address
1125 W Jackson St
Phoenix, AZ 85007-3110
Phone
(602) 776-0776
Fax
(602) 705-0567
NPI assigned
Dec 13, 2017
Last updated
Dec 13, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2017

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

Authorized official

Name
Brandon Clark
Title
Ceo
Phone
(602) 776-0776

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1125 W Jackson St
Phoenix, AZ 85007-3110

Mailing address

300 W Clarendon Ave Ste 200
Phoenix, AZ 85013-3422
Phone (602) 776-0776

Other names 1

  • Circle the City Family Health Center, After Hours Clinic - LDRC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150609001984 AZ Part B Supplier - Clinic/Group Practice 3971824442 Receives reassigned benefits from 68 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phoenix, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497260426. Details of each certification follow.

  • CCN 031971 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 031971

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CIRCLE THE CITY AFTER HOURS CLINIC- LDRC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 21, 2018
Last certification
Mar 21, 2018
Ownership / control type
Non-profit – church related
Facility address
1125 West Jackson Street, Suite 448
Phoenix, AZ 85007

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1125 W Jackson St
#448
Phoenix, AZ 85007
Phone (602) 776-7676

Practitioners & affiliated clinicians

Practitioners 3

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": "1513123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513123200000",
    "number": "1497260426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W CLARENDON AVE STE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133422",
            "telephone_number": "602-776-0776",
            "fax_number": "602-705-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 W JACKSON ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850073110",
            "telephone_number": "602-776-0776",
            "fax_number": "602-705-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIRCLE THE CITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-13",
        "last_updated": "2017-12-13",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-776-0776"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Circle the City Family Health Center, After Hours Clinic - LDRC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.