NPIMap

Organization Active NPI

McKellips Family Medical Clinic, PLLC

  • Family Medicine Physician
  • Mesa, AZ
National Provider Identifier
1659787497
Registry record updated Nov 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MCKELLIPS FAMILY MEDICAL CLINIC, PLLC
Practice address
3514 N Power Rd
BLDG. 1, Suite 105
Mesa, AZ 85215-8521
Phone
(480) 422-8533
NPI assigned
Jul 1, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2019

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

Authorized official

Name
Carl Ferguson, DONPI 1619068681
Title
Provider
Phone
(480) 830-1553

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

3514 N Power Rd
BLDG. 1, Suite 105
Mesa, AZ 85215-8521

Mailing address

3514 N Power Rd Ste 105
Mesa, AZ 85215-2907
Phone (480) 422-8533

Other identifiers 2

IdentifierTypeStateIssuer
273665MedicaidAZ
7200350001OtherAZPTAN

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to 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.

NPI Registry JSON

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

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572566400000",
    "number": "1659787497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3514 N POWER RD STE 105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852152907",
            "telephone_number": "480-422-8533",
            "fax_number": "480-981-2442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3514 N POWER RD",
            "address_2": "BLDG. 1, SUITE 105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852158521",
            "telephone_number": "480-422-8533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKELLIPS FAMILY MEDICAL CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-01",
        "last_updated": "2019-11-01",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "CARL",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "480-830-1553",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273665",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "7200350001",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2019; 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.