Active NPI
Marcus Lewis
- Prevention Professional
- Mesa, AZ
National Provider Identifier
1760923726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 81-5054569
- Practice address
- 1550 E University Dr
Suite G
Mesa, AZ 85203-8136 - Phone
- (602) 369-3497
- Fax
- (480) 921-4115
- NPI assigned
- Mar 10, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 81-5054569 | AZ | Primary |
Addresses
Primary practice location
1550 E University Dr
Suite G
Mesa, AZ 85203-8136
Mailing address
1550 E University Dr
Suite G
Mesa, AZ 85203-8136
Phone (602) 369-3497
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 81-5054569 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 81-5054569 | AZ | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489104000000",
"number": "1760923726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1550 E UNIVERSITY DR",
"address_2": "SUITE G",
"city": "MESA",
"state": "AZ",
"postal_code": "852038136",
"telephone_number": "602-369-3497",
"fax_number": "480-921-4115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1550 E UNIVERSITY DR",
"address_2": "SUITE G",
"city": "MESA",
"state": "AZ",
"postal_code": "852038136",
"telephone_number": "602-369-3497",
"fax_number": "480-921-4115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "MARCUS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-03-10",
"last_updated": "2017-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "AZ",
"license": "81-5054569",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "81-5054569",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.