NPIMap

Individual provider Active NPI

Pete Banchuin, MD

  • Family Medicine Physician
  • Chino Valley, AZ
National Provider Identifier
1568811024
Registry record updated Jan 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
59230 Issued in AZ
Practice address
474 N Highway 89
Chino Valley, AZ 86323-5993
Phone
(928) 636-5680
Fax
(928) 636-5853
NPI assigned
Jun 6, 2016
Last updated
Jan 31, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TL0006259 CO
Family Medicine Physician 207Q00000X 59230 AZ Primary

Addresses

Primary practice location

474 N Highway 89
Chino Valley, AZ 86323-5993

Mailing address

PO Box 10880
Prescott, AZ 86304-0880
Phone (602) 406-4786

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191003002942 AZ Practitioner - Family Practice 6507123544 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1000 Willow Creek Rd
Suite B
Prescott, AZ 86301-1645
Phone (928) 493-0072

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
TL0006259COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yavapai Regional Medical Center Physician Care LLC Current Accepting new patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Nov 4, 2019 Accepting new patients
Yavapai Regional Medical Center Physician Care LLC Family Medicine Past Accepting new patients
Prescott Gastroenterology Past Accepting new patients

Locations

474 N US Highway 89
Chino Valley, AZ 86323
Phone (520) 636-4355

1000 Willow Creek Rd
Ste B
Prescott, AZ 86301
Phone (928) 778-0330

1050 Gail Gardner Way
Ste 300
Prescott, AZ 86305
Phone (928) 717-5232

3120 Clearwater Dr
Prescott, AZ 86305
Phone (928) 445-4818

7700 E Florentine Rd
Ste 101
Prescott Valley, AZ 86314
Phone (928) 442-8710

Organizations & group practices 4

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1465171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1568811024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 N HIGHWAY 89",
            "city": "CHINO VALLEY",
            "state": "AZ",
            "postal_code": "863235993",
            "telephone_number": "928-636-5680",
            "fax_number": "928-636-5853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANCHUIN",
        "first_name": "PETE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-06",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "TL0006259",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "59230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino Valley, AZ

Sources for this page

Verify at the official NPI Registry.