Organization Active NPI

Archwell Health Professional Services of Arizona, LLC

  • Internal Medicine Physician
  • Mesa, AZ
National Provider Identifier
1558026880
Registry record updated Mar 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ARCHWELL HEALTH PROFESSIONAL SERVICES OF ARIZONA, LLC
Practice address
4315 E Main St
Mesa, AZ 85205-8605
Phone
(480) 870-7500
Fax
(480) 906-2173
NPI assigned
Nov 2, 2021
Last updated
Mar 11, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2026

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

Authorized official

Name
Amy Moddesette
Title
Sr. Director, Managed Care Ops
Phone
(629) 224-1614

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X
Internal Medicine Physician 207R00000X Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X

Addresses

Primary practice location

4315 E Main St
Mesa, AZ 85205-8605

Mailing address

102 Woodmont Blvd Ste 600
Nashville, TN 37205-5250

Other practice location 1

4220 W Bethany Home Rd
Phoenix, AZ 85019-1808
Phone (623) 281-1258

Other practice location 2

725 W Apache Trl Ste 4
Apache Junction, AZ 85120-3963
Phone (480) 870-7130

Other practice location 3

4420 E McDowell Rd
Phoenix, AZ 85008-4504
Phone (602) 858-4295

Other practice location 4

8913 N 19th Ave
Phoenix, AZ 85021-4206
Phone (602) 858-4361

Other practice location 5

2940 S 6th Ave
Tucson, AZ 85713-4705
Phone (520) 613-1001

Other practice location 6

5455 E Speedway Blvd
Tucson, AZ 85712-4923
Phone (520) 505-8912

Other practice location 7

6843 E Main St
Mesa, AZ 85207-8207
Phone (480) 870-7300

Other practice location 8

1060 E Southern Ave Ste 106
Mesa, AZ 85204-5058
Phone (480) 870-7400

Other practice location 9

2265 W Ina Rd
Tucson, AZ 85741-2650
Phone (520) 702-3637

Other practice location 10

10050 W Bell Rd Ste 35
Sun City, AZ 85351-1290
Phone (623) 281-1130

Other practice location 11

5100 E Broadway Blvd
Tucson, AZ 85711-3762
Phone (520) 613-3001

Other practice location 12

9550 E Golf Links Rd Ste 100
Tucson, AZ 85730-1400
Phone (520) 910-0207

Other practice location 13

1740 E Fort Lowell Rd Ste 100
Tucson, AZ 85719-2384
Phone (520) 613-0001

Other practice location 14

17674 N Litchfield Rd
Surprise, AZ 85374-2478
Phone (623) 281-3001

Other practice location 15

9750 W Peoria Ave Ste 120
Peoria, AZ 85345-6108
Phone (623) 281-1620

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221031001469 AZ Part B Supplier - Clinic/Group Practice 9830566199 Receives reassigned benefits from 112 practitioners
Practice locations: Tucson, AZ; Phoenix, AZ; Surprise, AZ; Sun City, AZ; Apache Junction, AZ; Mesa, AZ; Peoria, AZ

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
03D2266546Archwell Health Professional Services of Arizona,6843 E Main St, Mesa, AZ 85207Certificate of waiverAug 10, 2026
03D2266547Archwell Health Professional Services of Arizona1060 E Southern Ave Ste 106, Mesa, AZ 85204Certificate of waiverAug 10, 2026
03D2266719Archwell Health Professional Services of Arizona10050 W Bell Rd Ste 35, Sun City, AZ 85351Certificate of waiverAug 14, 2026
03D2266720Archwell Health Professional Services of Arizona4220 W Bethany Home Rd, Phoenix, AZ 85019Certificate of waiverAug 14, 2026
03D2266721Archwell Health Professional Services of Arizona4315 E Main St, Mesa, AZ 85205Certificate of waiverAug 14, 2026
03D2266725Archwell Health Professional Services of Arizona725 Apache Trail Ste 4, Apache Junction, AZ 85120Certificate of waiverAug 14, 2026
03D2266726Archwell Health Professional Services of Arizona4420 E McDowell Rd, Phoenix, AZ 85008Certificate of waiverAug 14, 2026
03D2266727Archwell Health Professional Services of Arizona17674 N Litchfield Rd, Surprise, AZ 85374Certificate of waiverAug 14, 2026
03D2266922Archwell Health Professional Services of Arizona8913 N 19TH Ave, Phoenix, AZ 85021Certificate of waiverAug 16, 2026
03D2266926Archwell Health Professional Services of Arizona2940 S 6TH Ave, Tucson, AZ 85713Certificate of waiverAug 16, 2026
03D2266929Archwell Health Professional Services of Arizona9750 W Peoria Ave, Peoria, AZ 85345Certificate of waiverAug 16, 2026
03D2266930Archwell Health Professional Services of Arizona1740 E Fort Lowell Rd Ste 100, Tucson, AZ 85719Certificate of waiverAug 16, 2026
03D2266932Archwell Health Professional Services of Arizona5100 E Broadway, Tucson, AZ 85711Certificate of waiverAug 16, 2026
03D2315292Archwell Health Professional Services of Arizona2265 W Ina Rd, Tucson, AZ 85741Certificate of waiverDec 9, 2026
03D2318318Archwell Health Professional Services of Arizona,9550 E Golf Links Rd Ste 100, Tucson, AZ 85730Certificate of waiverFeb 9, 2027
03D2324966Archwell Health Professional Services of Arizona5455 E Speedway Blvd, Tucson, AZ 85712Certificate of waiverJun 3, 2027

National Provider Directory

National Provider Directory

Locations

725 W Apache Trl
Ste 4
Apache Junction, AZ 85120
Phone (480) 870-7130

1060 E Southern Ave
Ste 106
Mesa, AZ 85204
Phone (480) 870-7400

6843 E Main St
Mesa, AZ 85207
Phone (480) 870-7300

9750 W Peoria Ave
Peoria, AZ 85345
Phone (623) 281-1620

9750 W Peoria Ave
Ste 120
Peoria, AZ 85345
Phone (623) 281-1620

4220 W Bethany Home Rd
Phoenix, AZ 85019
Phone (623) 281-1258

4420 E McDowell Rd
Phoenix, AZ 85008
Phone (602) 858-4295

8913 N 19th Ave
Phoenix, AZ 85021
Phone (602) 858-4361

10050 W Bell Rd
Ste 35
Sun City, AZ 85351
Phone (623) 281-1130

17674 N Litchfield Rd
Surprise, AZ 85374
Phone (623) 281-3001

1740 E Fort Lowell Rd
Ste 100
Tucson, AZ 85719
Phone (520) 613-0001

2265 W Ina Rd
Tucson, AZ 85741
Phone (520) 702-3637

2940 S 6th Ave
Tucson, AZ 85713
Phone (520) 613-1001

9550 E Golf Links Rd
Ste 100
Tucson, AZ 85730
Phone (520) 910-0207

Practitioners & affiliated clinicians

Practitioners 126

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 126

NPI Registry JSON

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

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773187200000",
    "number": "1558026880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WOODMONT BLVD STE 600",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372055250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4315 E MAIN ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852058605",
            "telephone_number": "480-870-7500",
            "fax_number": "480-906-2173"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4220 W Bethany Home Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850191808",
            "country_code": "US",
            "telephone_number": "623-281-1258",
            "fax_number": "480-906-2175",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "725 W Apache Trl Ste 4",
            "address_purpose": "LOCATION",
            "city": "Apache Junction",
            "state": "AZ",
            "postal_code": "851203963",
            "country_code": "US",
            "telephone_number": "480-870-7130",
            "fax_number": "480-906-2171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4420 E McDowell Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850084504",
            "country_code": "US",
            "telephone_number": "602-858-4295",
            "fax_number": "480-906-2177",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8913 N 19th Ave",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850214206",
            "country_code": "US",
            "telephone_number": "602-858-4361",
            "fax_number": "480-906-2176",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2940 S 6th Ave",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857134705",
            "country_code": "US",
            "telephone_number": "520-613-1001",
            "fax_number": "520-504-6483",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5455 E Speedway Blvd",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857124923",
            "country_code": "US",
            "telephone_number": "520-505-8912",
            "fax_number": "888-355-6926",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6843 E Main St",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852078207",
            "country_code": "US",
            "telephone_number": "480-870-7300",
            "fax_number": "480-906-2172",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1060 E Southern Ave Ste 106",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852045058",
            "country_code": "US",
            "telephone_number": "480-870-7400",
            "fax_number": "480-906-2174",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2265 W Ina Rd",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857412650",
            "country_code": "US",
            "telephone_number": "520-702-3637",
            "fax_number": "855-576-4111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10050 W Bell Rd Ste 35",
            "address_purpose": "LOCATION",
            "city": "Sun City",
            "state": "AZ",
            "postal_code": "853511290",
            "country_code": "US",
            "telephone_number": "623-281-1130",
            "fax_number": "480-906-2179",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5100 E Broadway Blvd",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857113762",
            "country_code": "US",
            "telephone_number": "520-613-3001",
            "fax_number": "520-504-6481",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9550 E Golf Links Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857301400",
            "country_code": "US",
            "telephone_number": "520-910-0207",
            "fax_number": "855-576-4748",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1740 E Fort Lowell Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857192384",
            "country_code": "US",
            "telephone_number": "520-613-0001",
            "fax_number": "520-504-6482",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17674 N Litchfield Rd",
            "address_purpose": "LOCATION",
            "city": "Surprise",
            "state": "AZ",
            "postal_code": "853742478",
            "country_code": "US",
            "telephone_number": "623-281-3001",
            "fax_number": "480-906-2180",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9750 W Peoria Ave Ste 120",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853456108",
            "country_code": "US",
            "telephone_number": "623-281-1620",
            "fax_number": "480-906-2178",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ARCHWELL HEALTH PROFESSIONAL SERVICES OF ARIZONA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-02",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A",
        "authorized_official_last_name": "MODDESETTE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "SR. DIRECTOR, MANAGED CARE OPS",
        "authorized_official_telephone_number": "629-224-1614"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "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 Mar 11, 2026; 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.