NPIMap

Organization Active NPI

Sun Life Family Health Center, Inc.

  • Community/Retail Pharmacy
  • San Manuel, AZ
National Provider Identifier
1851457295
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SUN LIFE FAMILY HEALTH CENTER, INC.
Practice address
23 McNab Parkway
San Manuel, AZ 85631
Phone
(520) 385-2236
Fax
(520) 381-3237
NPI assigned
Dec 29, 2006
Last updated
Aug 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2024

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

Authorized official

Name
Matthew Bertsch
Title
Director of Pharmacy/Ao
Phone
(520) 836-3446

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X Y03203 AZ
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

23 McNab Parkway
San Manuel, AZ 85631

Mailing address

PO Box 10097
Casa Grande, AZ 85130-0020
Phone (520) 836-3446

Other identifiers 2

IdentifierTypeStateIssuer
494576MedicaidAZ
0324070OtherAZNCPDP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220211001481 AZ Part B Supplier - Pharmacy 9335032275 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Florence, AZ; San Manuel, AZ; Maricopa, AZ; Eloy, AZ; Casa Grande, AZ; Apache Junction, AZ

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
W Pinal Family Health C15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1851457295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10097",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851300020",
            "telephone_number": "520-836-3446",
            "fax_number": "520-381-3237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 MCNAB PARKWAY",
            "city": "SAN MANUEL",
            "state": "AZ",
            "postal_code": "85631",
            "telephone_number": "520-385-2236",
            "fax_number": "520-381-3237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN LIFE FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "BERTSCH",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY/AO",
        "authorized_official_telephone_number": "520-836-3446"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "Y03203",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "494576",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0324070",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Manuel, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.