Active NPI
Georgeta Moisiu
- Adult Care Home Facility
- Surprise, AZ
National Provider Identifier
1750679239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Care Home Facility
- License
- AL6904H
- Practice address
- 13535 W Canyon Creek Dr
Surprise, AZ 85374-5407 - Phone
- (623) 594-2294
- Fax
- (623) 328-7031
- NPI assigned
- Jul 18, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | AL6904H | AZ | Primary |
Addresses
Primary practice location
13535 W Canyon Creek Dr
Surprise, AZ 85374-5407
Mailing address
13535 W Canyon Creek Dr
Surprise, AZ 85374-5407
Phone (623) 594-2294
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 572046 | Other | AZ | AHCCCS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL6904H | AZ | MD | Adult Care Home Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Triad Clinic PLLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Nurse Practitioner
- Glendale, AZ
- NPI 1174857791
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310947200000",
"number": "1750679239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13535 W CANYON CREEK DR",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853745407",
"telephone_number": "623-594-2294",
"fax_number": "623-328-7031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13535 W CANYON CREEK DR",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853745407",
"telephone_number": "623-594-2294",
"fax_number": "623-328-7031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOISIU",
"first_name": "GEORGETA",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-18",
"last_updated": "2011-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": "AZ",
"license": "AL6904H",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS",
"identifier": "572046",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Surprise, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.