NPIMap

Organization Active NPI

Spectrum Healthcare Group, Inc

  • Pediatrics Physician
  • Cottonwood, AZ
National Provider Identifier
1770917007
Registry record updated Jun 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
OTC5537 Issued in AZ
Legal business name
SPECTRUM HEALTHCARE GROUP, INC
Practice address
214 S Main St
Cottonwood, AZ 86326-3907
Phone
(928) 634-7534
Fax
(928) 634-9642
NPI assigned
Aug 22, 2013
Organization subpart
Yes
Parent organization
VERDE VALLEY GUIDANCE CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 5, 2014

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

Authorized official

Name
Connie Svaleng
Title
Cfo
Phone
(928) 634-2236

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X OTC5537 AZ
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X OTC5537 AZ Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X OTC5537 AZ
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X OTC5537 AZ

Addresses

Primary practice location

214 S Main St
Cottonwood, AZ 86326-3907

Mailing address

8 E Cottonwood St
Cottonwood, AZ 86326-6237
Phone (928) 203-5404

Other names 1

  • Valley Medical Center Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031223000698 AZ Part B Supplier - Clinic/Group Practice 3072411388 Receives reassigned benefits from 57 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tucson, AZ; Prescott Valley, AZ; Cottonwood, AZ; Prescott, AZ; Phoenix, AZ

Other NPIs on the same Medicare enrollment 21

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

View all 21

National Provider Directory

National Provider Directory
Part of
Verde Valley Guidance C

NPI Registry JSON

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

{
    "created_epoch": "1377129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401926400000",
    "number": "1770917007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 E COTTONWOOD ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863266237",
            "telephone_number": "928-203-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 S MAIN ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863263907",
            "telephone_number": "928-634-7534",
            "fax_number": "928-634-9642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTHCARE GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VERDE VALLEY GUIDANCE CLINIC",
        "enumeration_date": "2013-08-22",
        "last_updated": "2014-06-05",
        "status": "A",
        "authorized_official_last_name": "SVALENG",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "928-634-2236"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "OTC5537",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "OTC5537",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "OTC5537",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "OTC5537",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Cottonwood, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2014; 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.