NPIMap

Organization Active NPI

Phoenix Cardiac Surgery

Doing business as Yavapai Cardiac Surgery

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Prescott, AZ
National Provider Identifier
1619169950
Registry record updated Jan 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
PHOENIX CARDIAC SURGERY
Doing business as
Yavapai Cardiac Surgery
Practice address
811 Ainsworth Dr
Suite 109
Prescott, AZ 86301-1687
Phone
(928) 771-5595
NPI assigned
Aug 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2015

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

Authorized official

Name
Dr. Pierre R Tibi, MD
Title
Owner
Phone
(602) 253-9168

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208G00000X Primary

Addresses

Primary practice location

811 Ainsworth Dr
Suite 109
Prescott, AZ 86301-1687

Mailing address

3131 E Clarendon Ave
Suite 102
Phoenix, AZ 85016-7069
Phone (602) 253-9168

Other identifiers 1

IdentifierTypeStateIssuer
938632MedicaidAZ

Other names 1

  • YAVAPAI CARDIAC SURGERY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040220000726 AZ Part B Supplier - Clinic/Group Practice 8426943036 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Flagstaff, AZ; Phoenix, AZ

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

1215 N Beaver St
#203
Flagstaff, AZ 86001
Phone (928) 773-2150

1144 E McDowell Rd
Ste 400
Phoenix, AZ 85006
Phone (602) 251-3128

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420588800000",
    "number": "1619169950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 E CLARENDON AVE",
            "address_2": "SUITE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850167069",
            "telephone_number": "602-253-9168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 AINSWORTH DR",
            "address_2": "SUITE 109",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011687",
            "telephone_number": "928-771-5595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX CARDIAC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-10",
        "last_updated": "2015-01-07",
        "status": "A",
        "authorized_official_last_name": "TIBI",
        "authorized_official_first_name": "PIERRE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-253-9168",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "938632",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "YAVAPAI CARDIAC SURGERY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; 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.