Individual provider Active NPI

Colin Bohannan, MD

  • Surgical Critical Care Physician
  • Mesa, AZ
National Provider Identifier
1760846570
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
69753 Issued in AZ
Practice address
2945 S Dobson Rd
Mesa, AZ 85202-7941
Phone
(480) 969-4138
NPI assigned
Apr 7, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X 69753 AZ Primary

Addresses

Primary practice location

2945 S Dobson Rd
Mesa, AZ 85202-7941

Mailing address

2320 N 3Rd St
Phoenix, AZ 85004-1303

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230822002860 AZ Practitioner - General Surgery 4385007475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Critical Care (Intensivists)
Education
Oregon Health Sciences University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arizona Advanced Surgery LLCGroup PAC ID 0547690166, 93 clinicians

Practice addresses (Care Compare)

2945 S Dobson Rd
Mesa, AZ 85202-7941
Phone (480) 969-4138

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.9 of 100Reported as group
Promoting interoperability
94
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona Advanced Surgery LLC Surgery CurrentSince Oct 1, 2023 Accepting new patients
Banner Desert Medical Center Past Accepting new patients

Locations

2945 S Dobson Rd
Mesa, AZ 85202
Phone (480) 699-2508

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

2945 S Dobson Rd
#2320N
Mesa, AZ 85202

2320 N 3rd St
Phoenix, AZ 85004
Phone (602) 258-3262

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IGJBCD

Organizations & group practices 2

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1459987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1760846570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 N 3RD ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2945 S DOBSON RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852027941",
            "telephone_number": "480-969-4138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOHANNAN",
        "first_name": "COLIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-07",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "AZ",
            "license": "69753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.