NPIMap

Organization Active NPI

Codac Health Recovery and Wellness

Doing business as CODAC at Alvernon

  • Community Health Clinic/Center
  • Tucson, AZ
National Provider Identifier
1578070447
Registry record updated Jan 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
CODAC HEALTH RECOVERY AND WELLNESS
Doing business as
CODAC at Alvernon
Practice address
630 N Alvernon Way Ste 161
Tucson, AZ 85711-1895
Phone
(520) 318-9222
Fax
(520) 318-9094
NPI assigned
Jan 2, 2018
Last updated
Jan 2, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
CODAC HEALTH RECOVERY AND WELLNESSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 2, 2018

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

Authorized official

Name
Paul AxinnNPI 1801189857
Title
Contracts and Credentialing Manager
Phone
(520) 202-1755

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

630 N Alvernon Way Ste 161
Tucson, AZ 85711-1895

Mailing address

1650 E Fort Lowell Rd Ste 202
Tucson, AZ 85719-2378
Phone (520) 327-4505

Other names 1

  • CODAC at Alvernon Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040426001693 AZ Part B Supplier - Clinic/Group Practice 6103813811 Receives reassigned benefits from 48 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tucson, AZ

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Codac Health Recovery13 organizations share this tax ID, including this one
Part of
Codac Health Recovery

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1075 E Fort Lowell Rd
Tucson, AZ 85719
Phone (520) 202-1960

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1514851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514851200000",
    "number": "1578070447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 E FORT LOWELL RD STE 202",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857192378",
            "telephone_number": "520-327-4505",
            "fax_number": "520-202-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 N ALVERNON WAY STE 161",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857111895",
            "telephone_number": "520-318-9222",
            "fax_number": "520-318-9094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CODAC HEALTH RECOVERY AND WELLNESS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CODAC HEALTH RECOVERY AND WELLNESS",
        "enumeration_date": "2018-01-02",
        "last_updated": "2018-01-02",
        "status": "A",
        "authorized_official_last_name": "AXINN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CONTRACTS AND CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "520-202-1755"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CODAC at Alvernon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2018; 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.