NPIMap

Organization Active NPI

Yavapai Community Hospital Association

Doing business as Yavapai Regional Medical Center General Surgery

  • Surgery Physician
  • Prescott, AZ
National Provider Identifier
1649464454
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
H0115 Issued in AZ
Legal business name
YAVAPAI COMMUNITY HOSPITAL ASSOCIATION
Doing business as
Yavapai Regional Medical Center General Surgery
Practice address
804 Ainsworth Drive Ste. 103
Prescott, AZ 86301-1624
Phone
(928) 445-2700
Fax
(928) 771-5785
NPI assigned
Sep 5, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
YAVAPAI COMMUNITY HOSPITAL ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Lee Livin
Title
Chief Financial Officer
Phone
(928) 771-5691

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X H3964 AZ
Surgery Physician 208600000X H0115 AZ Primary

Addresses

Primary practice location

804 Ainsworth Drive Ste. 103
Prescott, AZ 86301-1624

Mailing address

1003 Willow Creek Road
Prescott, AZ 86301-1641
Phone (928) 771-5695

Other names 1

  • Yavapai Regional Medical Center General Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000405 AZ Part B Supplier - Clinic/Group Practice 6608777024 Receives reassigned benefits from 84 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: 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
Yavapai Regional Med CT3 organizations share this tax ID, including this one
Part of
Yavapai Regional Med CT

Other organizations with this tax ID 2

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1649464454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 WILLOW CREEK ROAD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011641",
            "telephone_number": "928-771-5695",
            "fax_number": "928-458-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 AINSWORTH DRIVE STE. 103",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011624",
            "telephone_number": "928-445-2700",
            "fax_number": "928-771-5785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YAVAPAI COMMUNITY HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "YAVAPAI COMMUNITY HOSPITAL ASSOCIATION",
        "enumeration_date": "2007-09-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "LIVIN",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "928-771-5691",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "H3964",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "H0115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yavapai Regional Medical Center General 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 Jul 21, 2022; 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.