Individual provider Active NPI

Cameron J P Sembaluk, D.C.

  • Chiropractor
  • Mesa, AZ
National Provider Identifier
1497711923
Registry record updated Sep 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6060 Issued in AZ
Practice address
1954 S Dobson Rd
Suite 3
Mesa, AZ 85202-5660
Phone
(480) 345-2022
Fax
(480) 345-0022
NPI assigned
Apr 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 6060 AZ Primary

Addresses

Primary practice location

1954 S Dobson Rd
Suite 3
Mesa, AZ 85202-5660

Mailing address

1954 S Dobson Rd
Suite 3
Mesa, AZ 85202-5660
Phone (480) 345-2022

Other identifiers 1

IdentifierTypeStateIssuer
AZ0931800OtherAZBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050928001532 AZ Practitioner - Chiropractic 4981639846 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Western States College of Chiropractic, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1954 S Dobson Rd
Suite 3
Mesa, AZ 85202-5660
Phone (480) 345-2022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6060AZMDChiropractor

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283299200000",
    "number": "1497711923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1954 S DOBSON RD",
            "address_2": "SUITE 3",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852025660",
            "telephone_number": "480-345-2022",
            "fax_number": "480-345-0022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1954 S DOBSON RD",
            "address_2": "SUITE 3",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852025660",
            "telephone_number": "480-345-2022",
            "fax_number": "480-345-0022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEMBALUK",
        "first_name": "CAMERON",
        "middle_name": "J P",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-24",
        "last_updated": "2010-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "6060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "AZ0931800",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.