NPIMap

Organization Active NPI

Spectrum Healthcare Group, Inc

  • Family Medicine Physician
  • Prescott, AZ
National Provider Identifier
1750937868
Registry record updated Mar 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SPECTRUM HEALTHCARE GROUP, INC
Practice address
990 Willow Creek Rd
Prescott, AZ 86301-1640
Phone
(928) 634-2236
Fax
(928) 634-8960
NPI assigned
Aug 14, 2019
Last updated
Mar 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2020

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

Authorized official

Name
Corinne Bailey
Title
Credentialing Specialist
Phone
(928) 634-2236

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Pediatrics Physician 208000000X NU
General Practice Physician 208D00000X NU
Pain Medicine Physician 208VP0000X NU
Medical Physician Assistant 363AM0700X NU
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

990 Willow Creek Rd
Prescott, AZ 86301-1640

Mailing address

8 E Cottonwood St
Cottonwood, AZ 86326-4382
Phone (928) 634-2236

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031223000698 AZ Part B Supplier - Clinic/Group Practice 3072411388 Receives reassigned benefits from 57 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tucson, AZ; Prescott Valley, AZ; Cottonwood, AZ; Prescott, AZ; Phoenix, AZ

Other NPIs on the same Medicare enrollment 21

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

View all 21

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1565740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583712000000",
    "number": "1750937868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 E COTTONWOOD ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264382",
            "telephone_number": "928-634-2236",
            "fax_number": "928-634-8960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 WILLOW CREEK RD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011640",
            "telephone_number": "928-634-2236",
            "fax_number": "928-634-8960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTHCARE GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-14",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "CORINNE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "928-634-2236"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Mar 9, 2020; 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.