Organization Active NPI

Live Well Family Medicine PLC

  • Family Medicine Physician
  • Chandler, AZ
National Provider Identifier
1740698026
Registry record updated Jul 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
43025 Issued in AZ
Legal business name
LIVE WELL FAMILY MEDICINE PLC
Practice address
655 S Dobson Rd
Suite B-115
Chandler, AZ 85224-5667
Phone
(480) 800-3561
Fax
(480) 800-3562
NPI assigned
Jul 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2014

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

Authorized official

Name
Norma L Perales, MDNPI 1457405953
Title
Owner
Phone
(480) 800-3561

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 43025 AZ Primary

Addresses

Primary practice location

655 S Dobson Rd
Suite B-115
Chandler, AZ 85224-5667

Mailing address

655 S Dobson Rd
Suite B-115
Chandler, AZ 85224-5667
Phone (480) 800-3561

Other identifiers 1

IdentifierTypeStateIssuer
508572MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140808001110 AZ Part B Supplier - Clinic/Group Practice 8325265762 Receives reassigned benefits from 5 practitioners
Practice locations: Chandler, AZ

National Provider Directory

National Provider Directory

Locations

655 S Dobson Rd
Ste B115
Chandler, AZ 85224
Phone (480) 800-3561

2320 W Ray Rd
Ste 1
Chandler, AZ 85224
Phone (480) 800-3561

Practitioners & affiliated clinicians

Practitioners 5

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": "1406678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406678400000",
    "number": "1740698026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 S DOBSON RD",
            "address_2": "SUITE B-115",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852245667",
            "telephone_number": "480-800-3561",
            "fax_number": "480-800-3562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 S DOBSON RD",
            "address_2": "SUITE B-115",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852245667",
            "telephone_number": "480-800-3561",
            "fax_number": "480-800-3562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE WELL FAMILY MEDICINE PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-30",
        "last_updated": "2014-07-30",
        "status": "A",
        "authorized_official_last_name": "PERALES",
        "authorized_official_first_name": "NORMA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-800-3561",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "43025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "508572",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2014; 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.