NPIMap

Organization Active NPI

Atlantis Medical Group Az PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Phoenix, AZ
National Provider Identifier
1740610039
Registry record updated Aug 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
ATLANTIS MEDICAL GROUP AZ PLLC
Practice address
11047 N 19TH Ave
Phoenix, AZ 85029-4816
Phone
(602) 589-0500
Fax
(602) 314-4552
NPI assigned
Nov 22, 2013
Last updated
Aug 25, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2026

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

Authorized official

Name
Robert Preston Harper
Title
Credentialing Specialist
Phone
(505) 553-8466

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Anesthesiology) Physician 207LA0401X NU
Pain Medicine (Anesthesiology) Physician 207LP2900X NU Primary
Orthopaedic Hand Surgery Physician 207XS0106X NU
Pain Medicine Physician 208VP0000X NU
Foot & Ankle Surgery Podiatrist 213ES0103X NU

Addresses

Primary practice location

11047 N 19TH Ave
Phoenix, AZ 85029-4816

Mailing address

11047 N 19TH Ave
Phoenix, AZ 85029-4816
Phone (602) 802-8636

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140402002039 AZ Part B Supplier - Clinic/Group Practice 7214168368 Receives reassigned benefits from 3 practitioners
Practice locations: Cottonwood, AZ; Goodyear, AZ; Phoenix, AZ; Prescott Valley, AZ; Surprise, AZ; Tucson, AZ

National Provider Directory

National Provider Directory

Locations

11047 N 19th Ave
Phoenix, AZ 85029
Phone (602) 944-0072

4222 E Camelback Rd
Ste H105
Phoenix, AZ 85018
Phone (602) 432-8813

8046 E Yavapai Rd
Prescott Vly, AZ 86314
Phone (602) 671-1700

13967 W Grand Ave
Surprise, AZ 85374

13967 W Grand Ave
Ste C103
Surprise, AZ 85374
Phone (602) 671-1700

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1385078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787616000000",
    "number": "1740610039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11047 N 19TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294816",
            "telephone_number": "602-802-8636",
            "fax_number": "602-314-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11047 N 19TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294816",
            "telephone_number": "602-589-0500",
            "fax_number": "602-314-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIS MEDICAL GROUP AZ PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-22",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A",
        "authorized_official_last_name": "HARPER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "PRESTON",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "505-553-8466"
    },
    "taxonomies": [
        {
            "code": "207LA0401X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; 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.