Privia Medical Group Arizona, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PRIVIA MEDICAL GROUP ARIZONA, LLC

Practice address

111 W Cedar LN Ste a
Payson, AZ 85541-5417

Phone

(602) 633-3780

Fax

(602) 633-3782

NPI assigned

Feb 25, 2008

Last updated

May 2, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael McHorney

Title

Cfo

Phone

(602) 633-3838

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Privia Medical Group Arizona, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1760441141

  O20060309000742

  Same enrollment

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

CLIA laboratory certificates

Locations

Practitioners 202

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.

• Pallavi Bellamkonda, M.D.

  • Cardiovascular Disease Physician
  • Phoenix, AZ
  • NPI 1871718486
  NPD
• Rachael Bennett, FNP-C

  • Nurse Practitioner
  • Phoenix, AZ
  • NPI 1134764590
  NPD
• Rachael Lynn Daley, MSN

  • Adult Health Nurse Practitioner
  • Avondale, AZ
  • NPI 1558577320
  NPD
• Kristina Deveau, NP-C

  • Nurse Practitioner
  • Goodyear, AZ
  • NPI 1528511482

  Family Medicine

  NPD
• Michael Scott Drury, M.D.

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1568462893
  NPD
• Rosa M Gomez, FNP-C

  • Family Nurse Practitioner
  • Avondale, AZ
  • NPI 1891573176
  NPD
• Morgan Gonzalez, FNP-C

  • Family Nurse Practitioner
  • Payson, AZ
  • NPI 1770274847
  NPD
• Michael Randall Keller, MD

  • Family Medicine Physician
  • Glendale, AZ
  • NPI 1821062183
  NPD
• Ronald W Kennett, D.O.

  • Internal Medicine Physician
  • Goodyear, AZ
  • NPI 1154318996
  NPD
• Muhammad Zain Khan Khakwani, MD

  • Interventional Cardiology Physician
  • Avondale, AZ
  • NPI 1710353123

  Family Medicine

  NPD
• Kia Lambeth

  • Nurse Practitioner
  • Avondale, AZ
  • NPI 1033622295
  NPD
• Mark Ralph Lonquist, MD

  • Family Medicine Physician
  • Goodyear, AZ
  • NPI 1629064613
  NPD

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

{
    "created_epoch": "1203897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746144000000",
    "number": "1740459700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 E BELL RD STE 4500",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322171",
            "telephone_number": "602-633-3838",
            "fax_number": "602-633-3850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W CEDAR LN STE A",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415417",
            "telephone_number": "602-633-3780",
            "fax_number": "602-633-3782"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "255 N Central Blvd",
            "address_2": "Ste 5",
            "address_purpose": "LOCATION",
            "city": "Quartzsite",
            "state": "AZ",
            "postal_code": "85346",
            "country_code": "US",
            "telephone_number": "928-927-6105",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2971 Willow Creek Rd",
            "address_2": "Bldg 3",
            "address_purpose": "LOCATION",
            "city": "Prescott",
            "state": "AZ",
            "postal_code": "86301",
            "country_code": "US",
            "telephone_number": "928-277-8088",
            "fax_number": "928-460-5280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP ARIZONA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-25",
        "last_updated": "2025-05-02",
        "certification_date": "2025-05-02",
        "status": "A",
        "authorized_official_last_name": "MCHORNEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "602-633-3838"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "326831",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amalia D Pineres, MD
• Ponderosa Family Care, LLC
• Ponderosa Family Care, LLC
• Preferred Women's Care
• Joshua Lee Price, F.N.P.
• Angela Dawn Prock
• Andrew Quast, PA-C
• R M Arizona Holdings Inc (Life Line Ambulance)
• Rutul Rabari
• Walter Frederick Raddatz, PHARMACIST

• Family Medicine Physician in Payson, AZ
• Providers in Payson, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2025; 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.