Individual provider Active NPI

Jerrelle M Copeland, M.D.

  • Internal Medicine Physician
  • Gold Canyon, AZ
National Provider Identifier
1790784643
Registry record updated Feb 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25933 Issued in AZ
Practice address
6724 S Kings Ranch Rd Ste 102
Gold Canyon, AZ 85118-2963
Phone
(480) 626-4999
Fax
(480) 304-3239
NPI assigned
Jul 21, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25933 AZ Primary

Addresses

Primary practice location

6724 S Kings Ranch Rd Ste 102
Gold Canyon, AZ 85118-2963

Mailing address

6724 S Kings Ranch Rd Ste 102
Gold Canyon, AZ 85118-2963
Phone (480) 626-4999

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
I20051214000283 AZ Practitioner - Internal Medicine 5193746444 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Howard University College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6724 S Kings Ranch Rd
Suite 102
Gold Canyon, AZ 85118-2963
Phone (480) 525-6161

Hospital & facility affiliations

  • Banner Home Care-Arizona Home health agency, Mesa, AZ, CCN 037015
  • Banner Gateway Medical Center Hospital, Gilbert, AZ, CCN 030122
  • Banner Baywood Medical Center Hospital, Mesa, AZ, CCN 030088

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Gold Canyon Internal Medicine, PLLC Internal Medicine Current Accepting new patients

Locations

5440 E Southern Ave
Ste 105
Mesa, AZ 85206
Phone (480) 644-0424

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": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769990400000",
    "number": "1790784643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6724 S KINGS RANCH RD STE 102",
            "city": "GOLD CANYON",
            "state": "AZ",
            "postal_code": "851182963",
            "telephone_number": "480-626-4999",
            "fax_number": "480-304-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6724 S KINGS RANCH RD STE 102",
            "city": "GOLD CANYON",
            "state": "AZ",
            "postal_code": "851182963",
            "telephone_number": "480-626-4999",
            "fax_number": "480-304-3239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPELAND",
        "first_name": "JERRELLE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-21",
        "last_updated": "2026-02-02",
        "certification_date": "2026-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "25933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gold Canyon, AZ

Sources for this page

Verify at the official NPI Registry.