Ali Etman

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

70200 Issued in AZ

Practice address

1300 N 12TH St Ste 605
Phoenix, AZ 85006-2850

Phone

(602) 839-4567

NPI assigned

Apr 3, 2020

Last updated

Oct 16, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Utah School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Banner Primary Care Physicians Arizona LLCGroup PAC ID 6406020155, 236 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner Home Care-Arizona Home health agency, Mesa, AZ, CCN 037015

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1659640902
  Medicare reassignment Care Compare group NPD
• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1790306066
  NPD
• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1417238908
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Banner Home Care-Arizona

  • Home Health Agency
  • Sun City, AZ
  • NPI 1023051927
  Care Compare affiliation

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

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1760011514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 S COUNTRY CLUB DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852105162",
            "telephone_number": "480-827-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N 12TH ST STE 605",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062850",
            "telephone_number": "602-839-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETMAN",
        "first_name": "ALI",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-03",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "70200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eternity Services LLC
• Cristina Rose Etienne, P.A.
• Gregory C Etienne, PA
• Samantha Valerie Etienne, MD
• Samuel Lucas Etling
• Saslee Etrata-Daite
• Kristal Rayne Etsitty
• Alexander Etu
• Akaninyene Etukudoh, PMHNP
• Aniema James Etukudoh

• Family Medicine Physician in Phoenix, AZ
• Providers in Phoenix, 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 Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.