Individual provider Active NPI

Sarah L Bruner, FNP-C

  • Family Nurse Practitioner
  • Tempe, AZ
National Provider Identifier
1710104229
Registry record updated Jul 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
TAP11419 Issued in AZ
Practice address
5030 S Mill Ave Ste D12
Tempe, AZ 85282
Phone
(480) 894-2823
Fax
(480) 756-6663
NPI assigned
Apr 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X TAP11419 AZ Primary

Addresses

Primary practice location

5030 S Mill Ave Ste D12
Tempe, AZ 85282

Mailing address

5030 S Mill Ave Ste D12
Tempe, AZ 85282-6849
Phone (480) 894-2823

Other practice location 1

353 W Verde Ln
Tempe, AZ 85284-1343
Phone (480) 200-3923

Other identifiers 1

IdentifierTypeStateIssuer
743337MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181022002334 AZ Practitioner - Nurse Practitioner 2769735711 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
TAP11419AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Medical Group, LLC CurrentSince Jul 25, 2018 Accepting new patients

Locations

5030 S Mill Ave
Ste D12
Tempe, AZ 85282
Phone (480) 894-2823

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531526400000",
    "number": "1710104229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5030 S MILL AVE STE D12",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852826849",
            "telephone_number": "480-894-2823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5030 S MILL AVE STE D12",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "85282",
            "telephone_number": "480-894-2823",
            "fax_number": "480-756-6663"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "353 W Verde Ln",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852841343",
            "country_code": "US",
            "telephone_number": "480-200-3923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUNER",
        "first_name": "SARAH",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-19",
        "last_updated": "2018-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "TAP11419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "743337",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

Verify at the official NPI Registry.