Integrated Multi Specialty Medical Group

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

INTEGRATED MULTI SPECIALTY MEDICAL GROUP

Practice address

1440 E Nevada Highway 372 Ste 3
Pahrump, NV 89048-2184

Phone

(702) 483-3630

NPI assigned

Feb 1, 2022

Organization subpart

No

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

Authorized official

Name

Grace Carillo

Title

Credentialing

Phone

(702) 569-7244

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1643673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1649923400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S RANCHO DR STE A2",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891063870",
            "telephone_number": "702-483-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 E NEVADA HIGHWAY 372 STE 3",
            "city": "PAHRUMP",
            "state": "NV",
            "postal_code": "890482184",
            "telephone_number": "702-483-3630"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4200 W Charleston Blvd Bldg A",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891021625",
            "country_code": "US",
            "telephone_number": "702-483-3630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTEGRATED MULTI SPECIALTY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-01",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A",
        "authorized_official_last_name": "CARILLO",
        "authorized_official_first_name": "GRACE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "702-569-7244"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Pahrump, NV
• Providers in Pahrump, NV by specialty
• Psychiatry Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.