Individual provider Active NPI

Robinette Camille Reed, FNP-C

  • Family Nurse Practitioner
  • Buckeye, AZ
National Provider Identifier
1588909600
Registry record updated Apr 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP4710 Issued in AZ
Practice address
1500 S Watson Rd Ste C104
Buckeye, AZ 85326-8689
Phone
(623) 251-7559
Fax
(623) 266-4012
NPI assigned
Nov 29, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP4710 AZ Primary

Addresses

Primary practice location

1500 S Watson Rd Ste C104
Buckeye, AZ 85326-8689

Mailing address

3815 E Bell Rd Ste 2200
Phoenix, AZ 85032-2139
Phone (602) 633-3848

Other identifiers 2

IdentifierTypeStateIssuer
881842MedicaidAZ
Z163552OtherAZMEDICARE

Other names 1

  • Robinette Camille Simon Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140224002199 AZ Practitioner - Nurse Practitioner 0749410413

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP4710AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group Arizona, LLC Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1354147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556496000000",
    "number": "1588909600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 E BELL RD STE 2200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322139",
            "telephone_number": "602-633-3848",
            "fax_number": "602-633-3841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S WATSON RD STE C104",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853268689",
            "telephone_number": "623-251-7559",
            "fax_number": "623-266-4012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REED",
        "first_name": "ROBINETTE",
        "middle_name": "CAMILLE",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-29",
        "last_updated": "2019-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP4710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "881842",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z163552",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROBINETTE",
            "last_name": "SIMON",
            "middle_name": "CAMILLE",
            "credential": "FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Buckeye, AZ

Sources for this page

Verify at the official NPI Registry.