NPIMap

Organization Active NPI

Canyon Pain and Spine

  • Pain Medicine Physician
  • Mesa, AZ
National Provider Identifier
1518547769
Registry record updated Dec 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
CANYON PAIN AND SPINE
Practice address
10238 E Hampton Ave Ste 416
Mesa, AZ 85209-3320
Phone
(480) 561-5000
NPI assigned
Apr 12, 2021
Last updated
Dec 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2022

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

Authorized official

Name
Kirk BowdenNPI 1255592994
Title
Owner
Phone
(937) 206-0377

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU
Pain Medicine (Anesthesiology) Physician 207LP2900X NU
Pain Medicine Physician 208VP0000X NU Primary
Interventional Pain Medicine Physician 208VP0014X NU

Addresses

Primary practice location

10238 E Hampton Ave Ste 416
Mesa, AZ 85209-3320

Mailing address

4156 E Sierra Madre Ave
Gilbert, AZ 85296-3084

Other practice location 1

6320A W Union Hills Dr Ste 270
Glendale, AZ 85308-2151
Phone (480) 561-5000

Other practice location 2

14445 W McDowell Rd Unit A10
Goodyear, AZ 85395-2518
Phone (623) 232-8787

Other practice location 3

1425 S Higley Rd Ste 102
Gilbert, AZ 85296-4798
Phone (480) 561-5000

Other practice location 4

4540 E Baseline Rd Ste 117-118
Mesa, AZ 85206-4613
Phone (480) 561-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210527000959 AZ Part B Supplier - Clinic/Group Practice 3870992647 Receives reassigned benefits from 22 practitioners
Practice locations: Mesa, AZ; Tempe, AZ; Sun City, AZ; Goodyear, AZ; Glendale, AZ; Gilbert, AZ; Buckeye, AZ

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2215114Canyon Pain and Spine10238 E Hampton Ave Ste 416, Mesa, AZ 85209Certificate of waiverFeb 28, 2027

National Provider Directory

National Provider Directory

Locations

865 S Watson Rd
Ste 201
Buckeye, AZ 85326
Phone (623) 242-4205

6320 W Union Hills Dr
Ste 270
Glendale, AZ 85308
Phone (480) 865-2800

14445 W McDowell Rd
Unit A10
Goodyear, AZ 85395
Phone (623) 232-8787

4566 E Inverness Ave
Ste 108
Mesa, AZ 85206
Phone (480) 659-4811

1492 S Mill Ave
Ste 305
Tempe, AZ 85281

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1618185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672358400000",
    "number": "1518547769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4156 E SIERRA MADRE AVE",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852963084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10238 E HAMPTON AVE STE 416",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852093320",
            "telephone_number": "480-561-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6320A W Union Hills Dr Ste 270",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853082151",
            "country_code": "US",
            "telephone_number": "480-561-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14445 W McDowell Rd Unit A10",
            "address_purpose": "LOCATION",
            "city": "Goodyear",
            "state": "AZ",
            "postal_code": "853952518",
            "country_code": "US",
            "telephone_number": "623-232-8787",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1425 S Higley Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852964798",
            "country_code": "US",
            "telephone_number": "480-561-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4540 E Baseline Rd Ste 117-118",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852064613",
            "country_code": "US",
            "telephone_number": "480-561-5000",
            "fax_number": "480-984-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CANYON PAIN AND SPINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-12",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A",
        "authorized_official_last_name": "BOWDEN",
        "authorized_official_first_name": "KIRK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-206-0377"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "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 Dec 30, 2022; 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.