NPIMap

Organization Active NPI

Peak Mobile Wound Care Corp

  • MOHS-Micrographic Surgery Physician
  • Scottsdale, AZ
National Provider Identifier
1861259988
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
PEAK MOBILE WOUND CARE CORP
Doing business as
Peak Mobile Wound Care Corp
Practice address
9375 E. Shea Blvd
Suite 100
Scottsdale, AZ 85260
Phone
(623) 239-9174
NPI assigned
Mar 5, 2024
Organization subpart
Yes
Parent organization
PEAK MOBILE WOUND CARE CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Authorized official

Name
Adrian Miranda
Title
Dir-Contracts/Credentialing
Phone
(602) 570-3169

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X Primary
Pediatric Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NP0225X

Addresses

Primary practice location

9375 E. Shea Blvd
Suite 100
Scottsdale, AZ 85260

Mailing address

9375 E. Shea Blvd
Suite 100
Scottsdale, AZ 85260
Phone (623) 239-9174

Other names 1

  • PEAK MOBILE WOUND CARE CORP Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240515000473 AZ Part B Supplier - Clinic/Group Practice 9931540481 Receives reassigned benefits from 4 practitioners
Practice locations: Scottsdale, AZ

National Provider Directory

National Provider Directory
Part of
Peak Mobile Wound Care Corp

Practitioners & affiliated clinicians

Practitioners 4

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": "1709596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1861259988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9375 E. SHEA BLVD",
            "address_2": "SUITE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "85260",
            "telephone_number": "623-239-9174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9375 E. SHEA BLVD",
            "address_2": "SUITE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "85260",
            "telephone_number": "623-239-9174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK MOBILE WOUND CARE CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEAK MOBILE WOUND CARE CORP",
        "enumeration_date": "2024-03-05",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "MIRANDA",
        "authorized_official_first_name": "ADRIAN",
        "authorized_official_title_or_position": "DIR-CONTRACTS/CREDENTIALING",
        "authorized_official_telephone_number": "602-570-3169"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEAK MOBILE WOUND CARE CORP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Scottsdale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 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.