NPIMap

Organization Active NPI

Cedars Heart Clinic, LLC

  • Interventional Cardiology Physician
  • Casa Grande, AZ
National Provider Identifier
1689878241
Registry record updated Mar 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
29317 Issued in AZ
Legal business name
CEDARS HEART CLINIC, LLC
Practice address
1968 N Peart Rd
Building B, Suite 4
Casa Grande, AZ 85122-2495
Phone
(520) 836-6661
Fax
(520) 836-6663
NPI assigned
Jun 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2015

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

Authorized official

Name
Dr. Ziad Elghoul, MDNPI 1497787642
Title
Ceo
Phone
(480) 917-5900

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
Interventional Cardiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RI0011X 29317 AZ Primary
Medical Specialty Clinic/Center 261QM2500X

Addresses

Primary practice location

1968 N Peart Rd
Building B, Suite 4
Casa Grande, AZ 85122-2495

Mailing address

1968 N Peart Rd
Building B, Suite 4
Casa Grande, AZ 85122-2495
Phone (520) 836-6661

Other identifiers 1

IdentifierTypeStateIssuer
569048MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060923000054 AZ Part B Supplier - Clinic/Group Practice 1658376744 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Casa Grade, AZ; Chandler, AZ

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D1069287Cedars Heart Clinic, LLC1968 N Peart Rd BLDG B Ste 4, Casa Grande, AZ 85122Certificate of waiverMay 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cedars Heart Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1968 N Peart Rd
Ste 4
Casa Grande, AZ 85122
Phone (520) 836-6661

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JAEEBA

Practitioners & affiliated clinicians

Practitioners 10

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": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426118400000",
    "number": "1689878241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1968 N PEART RD",
            "address_2": "BUILDING B, SUITE 4",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851222495",
            "telephone_number": "520-836-6661",
            "fax_number": "520-836-6663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1968 N PEART RD",
            "address_2": "BUILDING B, SUITE 4",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851222495",
            "telephone_number": "520-836-6661",
            "fax_number": "520-836-6663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDARS HEART CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2015-03-12",
        "status": "A",
        "authorized_official_last_name": "ELGHOUL",
        "authorized_official_first_name": "ZIAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-917-5900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "AZ",
            "license": "29317",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "569048",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Casa Grande, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.