NPIMap

Organization Active NPI

Scottsdale Internal Medicine PLLC

  • Adult Health Clinical Nurse Specialist
  • Phoenix, AZ
National Provider Identifier
1790050409
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Clinical Nurse SpecialistTaxonomy code 364SA2200X
Legal business name
SCOTTSDALE INTERNAL MEDICINE PLLC
Practice address
4643 N 12TH St Ste 101
Phoenix, AZ 85014-4083
Phone
(602) 812-3789
NPI assigned
Mar 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Authorized official

Name
Mr. Charles Benjamin Evans II, MDNPI 1275754517
Title
Owner
Phone
(602) 292-0552

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Adult Health Clinical Nurse SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 364SA2200X Primary

Addresses

Primary practice location

4643 N 12TH St Ste 101
Phoenix, AZ 85014-4083

Mailing address

4643 N 12TH St Ste 101
Phoenix, AZ 85014-4083
Phone (602) 812-3789

Other practice location 1

13840 N Northsight Blvd Ste 121
Scottsdale, AZ 85260
Phone (480) 588-6924

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160621002453 AZ Part B Supplier - Clinic/Group Practice 8325339468 Receives reassigned benefits from 5 practitioners
Practice locations: Tempe, AZ

National Provider Directory

National Provider Directory

Locations

18205 N 51st Ave
Ste 121
Glendale, AZ 85308

4653 S Lakeshore Dr
Ste 2
Tempe, AZ 85282
Phone (480) 456-8981

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1790050409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4643 N 12TH ST STE 101",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850144083",
            "telephone_number": "602-812-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4643 N 12TH ST STE 101",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850144083",
            "telephone_number": "602-812-3789"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13840 N Northsight Blvd Ste 121",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "85260",
            "country_code": "US",
            "telephone_number": "480-588-6924",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SCOTTSDALE INTERNAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-13",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-292-0552",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 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.