NPIMap

Organization Active NPI

New Vida Medical LLC

  • Clinic/Center
  • Mesa, AZ
National Provider Identifier
1508689274
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 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
Last updated
Nov 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Authorized official

Name
Rachel Popowych
Title
Owner
Phone
(480) 497-5933

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250109001903 AZ Part B Supplier - Clinic/Group Practice 0042748691 Receives reassigned benefits from 3 practitioners
Practice locations: Mesa, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 95

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 95

NPI Registry JSON

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

{
    "created_epoch": "1730419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730419200000",
    "number": "1508689274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 838",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852990838",
            "telephone_number": "480-497-5933",
            "fax_number": "480-497-5934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3048 E BASELINE RD STE 122",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852047288",
            "telephone_number": "480-497-5933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW VIDA MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-01",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A",
        "authorized_official_last_name": "POPOWYCH",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-497-5933"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Nov 1, 2024; 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.