NPIMap

Organization Active NPI

Prescott Gastroenterology

  • Gastroenterology Physician
  • Prescott, AZ
National Provider Identifier
1720110984
Registry record updated Aug 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
22747 Issued in AZ
Legal business name
PRESCOTT GASTROENTEROLOGY
Practice address
811 Ainsworth Dr Ste 103
Prescott, AZ 86301-1687
Phone
(928) 771-5548
Fax
(928) 771-5549
NPI assigned
Mar 12, 2007
Last updated
Aug 27, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2010

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

Authorized official

Name
Mrs. Debbie Marie De Luna
Title
Office Manager
Phone
(928) 771-5548

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 22747 AZ Primary

Addresses

Primary practice location

811 Ainsworth Dr Ste 103
Prescott, AZ 86301-1687

Mailing address

811 Ainsworth Dr Ste 103
Prescott, AZ 86301-1687
Phone (928) 771-5548

Other identifiers 1

IdentifierTypeStateIssuer
176950MedicaidAZ

Other names 1

  • Prescott Gastroenterology Consultants Medical Group Other name

National Provider Directory

National Provider Directory

Locations

811 Ainsworth Dr
Ste 103
Prescott, AZ 86301
Phone (928) 771-5548

Practitioners & affiliated clinicians

Practitioners 113

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 113

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282867200000",
    "number": "1720110984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 AINSWORTH DR STE 103",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011687",
            "telephone_number": "928-771-5548",
            "fax_number": "928-771-5549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 AINSWORTH DR STE 103",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011687",
            "telephone_number": "928-771-5548",
            "fax_number": "928-771-5549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCOTT GASTROENTEROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2010-08-27",
        "status": "A",
        "authorized_official_last_name": "DE LUNA",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "928-771-5548",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AZ",
            "license": "22747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176950",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prescott Gastroenterology Consultants Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; 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.