NPIMap

Organization Active NPI

Pophealthcare Medical Services of Az, PC

  • Nurse Practitioner
  • Tempe, AZ
National Provider Identifier
1760884175
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
POPHEALTHCARE MEDICAL SERVICES OF AZ, PC
Practice address
1438 W Broadway Rd Ste 101
Tempe, AZ 85282-1173
Phone
(877) 358-8109
NPI assigned
Sep 17, 2014
Last updated
Jul 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Authorized official

Name
Susan Porter
Title
Manager, Credentialing & Licensing
Phone
(615) 630-0988

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X Primary
Adult Health Nurse Practitioner 363LA2200X

Addresses

Primary practice location

1438 W Broadway Rd Ste 101
Tempe, AZ 85282-1173

Mailing address

113 Seaboard LN Ste 200B
Franklin, TN 37067-8282
Phone (180) 079-3705

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150717001256 AZ Part B Supplier - Clinic/Group Practice 5799098844 Receives reassigned benefits from 41 practitioners
1 other NPI on this enrollment
Practice locations: Tempe, AZ

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

2141 E Broadway Rd
Ste 120
Tempe, AZ 85282
Phone (480) 237-5098

Practitioners & affiliated clinicians

Practitioners 44

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.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1760884175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 SEABOARD LN STE 200B",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370678282",
            "telephone_number": "180-079-3705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1438 W BROADWAY RD STE 101",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852821173",
            "telephone_number": "877-358-8109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POPHEALTHCARE MEDICAL SERVICES OF AZ, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-17",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "MANAGER, CREDENTIALING & LICENSING",
        "authorized_official_telephone_number": "615-630-0988"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; 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.