Black Diamond Medical LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

BLACK DIAMOND MEDICAL LLC

Practice address

20449 N Lake Pleasant Rd Ste 101
Peoria, AZ 85382-2707

Phone

(623) 322-0099

NPI assigned

Oct 12, 2018

Last updated

Mar 6, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tonia Lanette GrahamNPI 1699108621

Title

Co-Owner

Phone

(623) 322-0099

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18489/brand/1/csg/1/fhir/r4

Practitioners 3

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.

• Tonia Lanette Graham, FNP

  • Primary Care Nurse Practitioner
  • Peoria, AZ
  • NPI 1699108621
  Medicare reassignment NPD Authorized official
• Melody Dawn Austin, FNP

  • Family Nurse Practitioner
  • Peoria, AZ
  • NPI 1356768493
  NPD
• Kristin Leigh Serrato, FNP-C

  • Family Nurse Practitioner
  • Sun City, AZ
  • NPI 1063914398
  NPD (past)

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

{
    "created_epoch": "1539302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583452800000",
    "number": "1639644909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20449 N LAKE PLEASANT RD STE 101",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822707",
            "telephone_number": "623-322-0099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20449 N LAKE PLEASANT RD STE 101",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822707",
            "telephone_number": "623-322-0099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK DIAMOND MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-12",
        "last_updated": "2020-03-06",
        "certification_date": "2020-03-06",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "TONIA",
        "authorized_official_middle_name": "LANETTE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "623-322-0099"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Birkett, PA-C
• Birthing LLC
• Darrel Lee Bischoff, DDS
• Tatum Renee Bixler
• Black Diamond Behavior Consulting LLC
• Black Mountain Endodontics
• Iain Alan Black, PA-C
• Mary Catherine Blackburn, SLPA
• Cyntha Ann Blair, CCC-SLP
• Eric John Blasing, PT ATC

• Primary Care Nurse Practitioner in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Primary Care Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2020; 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.