NPIMap

Organization Active NPI

Foothills Blvd Clinic LLC

  • Family Medicine Physician
  • Yuma, AZ
National Provider Identifier
1801922356
Registry record updated Feb 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FOOTHILLS BLVD CLINIC LLC
Practice address
11611 S Foothills Blvd
Suite C
Yuma, AZ 85367
Phone
(928) 342-1814
Fax
(928) 342-6154
NPI assigned
Feb 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2012

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

Authorized official

Name
Dr. Stamatia Fissas Gockel, DONPI 1154487726
Title
Owner/Physician
Phone
(928) 342-1814

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

11611 S Foothills Blvd
Suite C
Yuma, AZ 85367

Mailing address

11611 S Foothills Blvd
Suite C
Yuma, AZ 85367
Phone (928) 342-1814

Other names 1

  • Foothills Blvd Clinic, LLC Doing business as

National Provider Directory

National Provider Directory

Locations

11611 S Foothills Blvd
Ste C
Yuma, AZ 85367
Phone (928) 247-9616

Practitioners & affiliated clinicians

Practitioners 1

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": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328227200000",
    "number": "1801922356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11611 S FOOTHILLS BLVD",
            "address_2": "SUITE C",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "85367",
            "telephone_number": "928-342-1814",
            "fax_number": "928-342-6154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11611 S FOOTHILLS BLVD",
            "address_2": "SUITE C",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "85367",
            "telephone_number": "928-342-1814",
            "fax_number": "928-342-6154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILLS BLVD CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2012-02-03",
        "status": "A",
        "authorized_official_last_name": "GOCKEL",
        "authorized_official_first_name": "STAMATIA",
        "authorized_official_middle_name": "FISSAS",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "928-342-1814",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foothills Blvd Clinic, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yuma, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.