NPIMap

Organization Active NPI

Adelante Healthcare, Inc.

Doing business as Adelante Healthcare-Buckeye

  • Federally Qualified Health Center (FQHC)
  • Buckeye, AZ
National Provider Identifier
1801954441
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ADELANTE HEALTHCARE, INC.
Doing business as
Adelante Healthcare-Buckeye
Practice address
306 E Monroe Ave
Buckeye, AZ 85326-2706
Phone
(480) 964-2273
Fax
(623) 386-4593
NPI assigned
Dec 5, 2006
Last updated
Apr 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

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

Authorized official

Name
Krystal Powell
Title
Revenue Cycle Director
Phone
(623) 583-3001

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Family Medicine Physician 207Q00000X AZ
Pediatrics Physician 208000000X AZ

Addresses

Primary practice location

306 E Monroe Ave
Buckeye, AZ 85326-2706

Mailing address

3033 N Central Ave Ste 145
Phoenix, AZ 85012-2808
Phone (623) 583-3001

Other names 1

  • Adelante Healthcare-Buckeye Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031114000335 AZ Part B Supplier - Clinic/Group Practice 4688588643 Receives reassigned benefits from 250 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gila Bend, AZ; Wickenburg, AZ; Surprise, AZ; Phoenix, AZ; Peoria, AZ; Mesa, AZ; Goodyear, AZ; Buckeye, AZ
O20090708000566 AZ Part A Provider - Federally Qualified Health Center (FQHC) 4688588643 1 other NPI on this enrollment
Practice locations: Buckeye, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801954441. Details of each certification follow.

Federally qualified health center certification: CCN 031821

Legal name
ADELANTE HEALTHCARE, INC
Doing business as
ADELANTE HEALTHCARE - BUCKEYE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 22, 1995
Last certification
Nov 22, 1995
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1980 in AZ
Enrollment address
306 E Monroe Ave
Buckeye, AZ 85326-2706

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Clinica Adelante Inc23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jan Hertzfeld Individual Corporate DirectorBoard Member Jun 24, 2021
Robert D Babyar Individual Corporate OfficerChief Medical Officer Sep 6, 2016 10%
Jill Rhodes Individual Corporate DirectorBoard Member Aug 5, 2022
Michael Ellenby Individual Corporate DirectorBoard Member Mar 22, 2018
Jason Reed Individual Corporate DirectorBoard Member Dec 21, 2017
Audrey Michelle Bohanan Individual Corporate OfficerChief People Officer Dec 11, 2011 10%
Guadalupe Campos Individual Corporate DirectorBoard Member May 27, 2021
Gordon L Grado Individual Corporate DirectorBoard Member Jul 23, 2015
Heather Boysel Individual Corporate DirectorBoard Member Jun 23, 2016
Sentari Mychale Minor Individual Corporate DirectorBoard Member Apr 3, 2015
Gabriel Ramirez Individual Corporate DirectorBoard Member Sep 28, 2017
Jennifer Halfar Individual W-2 Managing EmployeeSenior Billing Manager May 4, 2020
Nelida Acosta Individual Corporate DirectorBoard Member May 27, 2021
Raymond Arvizu Individual Corporate DirectorBoard Member Dec 6, 2022
Pedro Cons Individual Corporate OfficerChief Executive Officer Jul 6, 2020 40%
Darrell Wayne Leonard Individual Corporate DirectorBoard Member Jan 22, 2015
Jonae Harrison Individual Corporate OfficerChief Compliance Officer Mar 3, 2022 10%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1801954441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3033 N CENTRAL AVE STE 145",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122808",
            "telephone_number": "623-583-3001",
            "fax_number": "623-876-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 E MONROE AVE",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853262706",
            "telephone_number": "480-964-2273",
            "fax_number": "623-386-4593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADELANTE HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "KRYSTAL",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "623-583-3001"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adelante Healthcare-Buckeye",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Adelante Healthcare-Buckeye",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buckeye, AZ

Sources for this page

Verify at the official NPI Registry.