NPIMap

Organization Active NPI

Arizona Grand Medical Center PLLC

  • Multi-Specialty Clinic/Center
  • Prescott, AZ
National Provider Identifier
1619998705
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
ARIZONA GRAND MEDICAL CENTER PLLC
Practice address
3777 Crossings Dr
Prescott, AZ 86305-7121
Phone
(623) 934-5600
Fax
(623) 934-5603
NPI assigned
Jul 22, 2006
Organization subpart
Yes
Parent organization
ARIZONA GRAND MEDICAL CENTER PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Melissa Mayoral
Title
Accounts Manager
Phone
(602) 820-4709

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

3777 Crossings Dr
Prescott, AZ 86305-7121

Mailing address

PO Box 47729
Phoenix, AZ 85068-7729
Phone (623) 934-5600

Other practice location 1

3769 Crossings Dr Ste A
Prescott, AZ 86305-7270
Phone (928) 771-9314

Other identifiers 1

IdentifierTypeStateIssuer
CK3166OtherAZRAIL ROAD MEDICARE

Other names 1

  • Dewey Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040116000332 AZ Part B Supplier - Clinic/Group Practice 0840100608 Receives reassigned benefits from 3 practitioners
2 other NPIs on this enrollment
Practice locations: Dewey, AZ; Prescott, AZ; Prescott Valley, AZ

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Arizona Grand Medical C3 organizations share this tax ID, including this one
Part of
Arizona Grand Medical C

Other organizations with this tax ID 2

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

Locations

1590 Willow Creek Rd
Ste A
Prescott, AZ 86301
Phone (866) 439-7533

3773 Crossings Dr
Ste A
Prescott, AZ 86305
Phone (928) 277-8316

14973 W Bell Rd
Slp Ez
Surprise, AZ 85374
Phone (623) 398-6222

628 W Wickenburg Way
Wickenburg, AZ 85390
Phone (602) 226-8880

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1619998705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 47729",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850687729",
            "telephone_number": "623-934-5600",
            "fax_number": "623-934-5603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3777 CROSSINGS DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863057121",
            "telephone_number": "623-934-5600",
            "fax_number": "623-934-5603"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3769 Crossings Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Prescott",
            "state": "AZ",
            "postal_code": "863057270",
            "country_code": "US",
            "telephone_number": "928-771-9314",
            "fax_number": "888-370-5093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ARIZONA GRAND MEDICAL CENTER PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ARIZONA GRAND MEDICAL CENTER PLLC",
        "enumeration_date": "2006-07-22",
        "last_updated": "2025-09-02",
        "certification_date": "2025-02-12",
        "status": "A",
        "authorized_official_last_name": "MAYORAL",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "602-820-4709"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "CK3166",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dewey Medical Center",
            "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 Sep 2, 2025; 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.