Canyon Pain and Spine

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

CANYON PAIN AND SPINE

Practice address

1492 S Mill Ave Ste 305
Tempe, AZ 85281-5676

Phone

(480) 561-5000

Fax

(623) 232-2789

NPI assigned

Jul 10, 2023

Last updated

Jul 10, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kirk George Bowden

Title

Owner

Phone

(480) 889-0255

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Canyon Pain and Spine

  • Interventional Pain Medicine Physician
  • Glendale, AZ
  • NPI 1104590512

  3870992647

  Same PAC ID
• Canyon Pain and Spine

  • Durable Medical Equipment & Medical Supplies
  • Mesa, AZ
  • NPI 1144076829

  3870992647

  Same PAC ID
• Canyon Pain and Spine

  • Durable Medical Equipment & Medical Supplies
  • Buckeye, AZ
  • NPI 1467292938

  3870992647

  Same PAC ID
• Canyon Pain and Spine

  • Pain Medicine Physician
  • Mesa, AZ
  • NPI 1518547769

  3870992647

  Same PAC ID
• Canyon Pain and Spine

  • Interventional Pain Medicine Physician
  • Mesa, AZ
  • NPI 1770257180

  3870992647

  Same PAC ID
• Canyon Pain and Spine

  • Durable Medical Equipment & Medical Supplies
  • Gilbert, AZ
  • NPI 1962180844

  3870992647

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1801574785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1492 S MILL AVE STE 305",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852815676",
            "telephone_number": "480-561-5000",
            "fax_number": "623-232-2789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1492 S MILL AVE STE 305",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852815676",
            "telephone_number": "480-561-5000",
            "fax_number": "623-232-2789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON PAIN AND SPINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "BOWDEN",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-889-0255"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Canastillo Rodriguez
• Anthony John Canestraro, M.D.
• Richard Brooks Canfield, MC, CEAP, LPC
• Matthew J Cangemi, PHARM.D.
• Alice Mae Cannan, RBT
• Canyon River, LLC (Blue Swan Pharmacy- Tempe)
• Canyon River, LLC (Blue Swan Pharmacy- Tempe)
• Jacci Arden Caplin, MSW, LCSW
• Elizabeth Capps-Conkle, PSY.D.
• Freddie Carabajal, ATC

• Durable Medical Equipment & Medical Supplies in Tempe, AZ
• Providers in Tempe, AZ by specialty
• Durable Medical Equipment & Medical Supplies in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.