NPIMap

Organization Active NPI

Phoenix Heart, PLLC

  • Cardiovascular Disease Physician
  • Glendale, AZ
National Provider Identifier
1679608095
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
PHOENIX HEART, PLLC
Practice address
5859 W Talavi Blvd Ste 100
Glendale, AZ 85306-1870
Phone
(602) 298-7777
Fax
(623) 930-6060
NPI assigned
Feb 23, 2007
Last updated
Mar 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Authorized official

Name
Lysa Munhall
Title
Credentialing Manager
Phone
(602) 298-7777

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Family Nurse Practitioner 363LF0000X NU
Gerontology Nurse Practitioner 363LG0600X NU
Cardiovascular Disease Physician 207RC0000X NU Primary
Interventional Cardiology Physician 207RI0011X NU
Nuclear Cardiology Physician 207UN0901X NU

Addresses

Primary practice location

5859 W Talavi Blvd Ste 100
Glendale, AZ 85306-1870

Mailing address

5859 W Talavi Blvd Ste 100
Glendale, AZ 85306-1870
Phone (602) 298-7777

Other practice location 1

9040 Jackson Ave
Tacoma, WA 98431-0001
Phone (602) 908-8667

Other identifiers 3

IdentifierTypeStateIssuer
Z27785OtherAZMEDICARE PTAN
275622MedicaidAZ
Z212189OtherAZMEDICARE PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040719001045 AZ Part B Supplier - Clinic/Group Practice 7113906421 Receives reassigned benefits from 41 practitioners
Practice locations: Scottsdale, AZ; Peoria, AZ; Goodyear, AZ; Buckeye, AZ; Black Canyon City, AZ; Anthem, AZ; Glendale, AZ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

13028 W Rancho Santa Fe Blvd
#A
Avondale, AZ 85392

140 N Litchfield Rd
Ste 104
Goodyear, AZ 85338
Phone (480) 478-0444

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 51

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.

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615420800000",
    "number": "1679608095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5859 W TALAVI BLVD STE 100",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853061870",
            "telephone_number": "602-298-7777",
            "fax_number": "623-930-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5859 W TALAVI BLVD STE 100",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853061870",
            "telephone_number": "602-298-7777",
            "fax_number": "623-930-6060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9040 Jackson Ave",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984310001",
            "country_code": "US",
            "telephone_number": "602-908-8667",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHOENIX HEART, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-04",
        "status": "A",
        "authorized_official_last_name": "MUNHALL",
        "authorized_official_first_name": "LYSA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "602-298-7777"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z27785",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275622",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z212189",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; 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.