NPIMap

Organization Active NPI

Paradise Valley Family Medicine, PC

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1598872186
Registry record updated Feb 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PARADISE VALLEY FAMILY MEDICINE, PC
Practice address
11209 N Tatum Blvd
Suite 180
Phoenix, AZ 85028-3091
Phone
(602) 494-5155
Fax
(602) 494-5115
NPI assigned
Aug 23, 2006
Reactivated
Feb 11, 2020
Last updated
Feb 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2020

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

Authorized official

Name
Teresa J O'Brien
Title
Manager
Phone
(602) 494-5118

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

11209 N Tatum Blvd
Suite 180
Phoenix, AZ 85028-3091

Mailing address

11209 N. Tatum Blvd
Suite 180
Phoenix, AZ 85028
Phone (602) 494-5155

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040329001509 AZ Part B Supplier - Clinic/Group Practice 3375435761 Receives reassigned benefits from 11 practitioners
Practice locations: Phoenix, 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
03D0997703Paradise Valley Family Medicine11209 N Tatum Blvd Ste 180, Phoenix, AZ 85028Provider-performed microscopyMar 24, 2028

National Provider Directory

National Provider Directory

Locations

11209 N Tatum Blvd
Ste 180
Phoenix, AZ 85028
Phone (602) 494-5155

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GBCHBA

Practitioners & affiliated clinicians

Practitioners 88

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 88

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581379200000",
    "number": "1598872186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11209 N. TATUM BLVD",
            "address_2": "SUITE 180",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85028",
            "telephone_number": "602-494-5155",
            "fax_number": "602-494-5115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11209 N TATUM BLVD",
            "address_2": "SUITE 180",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850283091",
            "telephone_number": "602-494-5155",
            "fax_number": "602-494-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARADISE VALLEY FAMILY MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "deactivation_date": "2018-11-05",
        "reactivation_date": "2020-02-11",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "602-494-5118"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2020; 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.