NPIMap

Organization Active NPI

Phoenix Heart Ambulatory Surgery and Electrophysiology, LLC

Doing business as PHASE Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Glendale, AZ
National Provider Identifier
1760064885
Registry record updated Feb 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
PHOENIX HEART AMBULATORY SURGERY AND ELECTROPHYSIOLOGY, LLC
Doing business as
PHASE Surgery Center
Practice address
5859 W Talavi Blvd Ste 140
Glendale, AZ 85306-1871
Phone
(602) 806-0357
Fax
(623) 930-6060
NPI assigned
Apr 27, 2021
Last updated
Feb 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2023

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

Authorized official

Name
Jerry Van Horn
Title
Center Director
Phone
(602) 806-0357

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU
Clinical Cardiac Electrophysiology Physician 207RC0001X NU
Interventional Cardiology Physician 207RI0011X NU
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

5859 W Talavi Blvd Ste 140
Glendale, AZ 85306-1871

Mailing address

5859 W Talavi Blvd Ste 140
Glendale, AZ 85306-1871
Phone (602) 806-0357

Other names 1

  • PHASE Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210930003009 AZ Part B Supplier - Ambulatory Surgical Center 6507260148 Practice locations: Glendale, AZ

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Phoenix Heart Ambulatory Surgery and Electrophysiology LLC Dba Phase Surgery CenterCCN 03C0001449
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

5859 W Talavi Blvd
Ste 140
Glendale, AZ 85306
Phone (602) 741-1903

Practitioners & affiliated clinicians

Practitioners 9

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": "1619481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675641600000",
    "number": "1760064885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5859 W TALAVI BLVD STE 140",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853061871",
            "telephone_number": "602-806-0357",
            "fax_number": "623-930-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5859 W TALAVI BLVD STE 140",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853061871",
            "telephone_number": "602-806-0357",
            "fax_number": "623-930-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HEART AMBULATORY SURGERY AND ELECTROPHYSIOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-27",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A",
        "authorized_official_last_name": "VAN HORN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "CENTER DIRECTOR",
        "authorized_official_telephone_number": "602-806-0357"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHASE Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PHASE Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.