New Vida Medical LLC
Organization Active NPI Clinic/Center · Mesa, AZ
NPI 1508689274 · NPPES record last updated Nov 1, 2024
Key facts
- NPI
- 1508689274
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- NEW VIDA MEDICAL LLC
- Practice address
- 3048 E Baseline Rd Ste 122
Mesa, AZ 85204-7288 - Phone
- (480) 497-5933
- NPI assigned
- Nov 1, 2024
- Organization subpart
- No
Authorized official
- Name
- Rachel Popowych
- Title
- Owner
- Phone
- (480) 497-5933
Practitioners 95
-
Rakesh Gaddam, M.D.
-
Ayad K Agha, D.O.
-
Bogdan Nicolae Anghel, M.D.
-
George M Armendariz, M.D.
-
Roberta Boon, F.N.P.-B.C.
-
Joel Braun, M.D.
-
Luther Charles, PA, MD
-
Jose J Cruz, DC
-
Jennifer Denise De la Garza, ACNPC-AG
-
Roxanna Donan, FNP-C
-
Carlos Roman Echevarria, MD, MMM
-
Marc Lewis Eckhauser, M.D.
-
Michael F Esber, DPM
-
Angelita Estrada, FNP
-
Kelli Raynell Favata, M.D.
-
Juan Felix, P.A
-
Christina Flores-Jurado, FNP-C
-
David Michael Franey, M.D.
-
Shannon Ganley, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250109001903 | AZ | Part B Supplier - Clinic/Group Practice | 0042748691 |
Receives reassigned benefits from 3 practitioners Practice locations: Mesa, AZ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
3048 E Baseline Rd Ste 122
Mesa, AZ 85204-7288
Mailing address
PO Box 838
Gilbert, AZ 85299-0838
Phone (480) 497-5933
Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.