Goldfield Medical Clinics, LLC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

Legal business name

GOLDFIELD MEDICAL CLINICS, LLC

Practice address

7615 E Baseline Rd Ste 101
Mesa, AZ 85209-2000

Phone

(480) 962-0101

Fax

(480) 962-0202

NPI assigned

Jul 21, 2006

Organization subpart

No

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

Authorized official

Name

Shantha KumarNPI 1396768958

Title

Owner

Phone

(480) 962-0101

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 2

• Goldfield Cardiovascular Institue Doing business as
• Goldfield Cardiovascular Institute LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

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

• Cobre Valley Heart Institute PLLC

  • Interventional Cardiology Physician
  • Globe, AZ
  • NPI 1134562267

  O20130514000337

  Same enrollment

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

CLIA laboratory certificates

Tax ID family

Cobre Valley Heart Institute2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Cobre Valley Heart Institute PLLC

  • Interventional Cardiology Physician
  • Globe, AZ
  • NPI 1134562267
  NPD tax ID

Locations

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shantha Kumar, M.D.

  • Cardiovascular Disease Physician
  • Apache Junction, AZ
  • NPI 1396768958

  Specialist

  Medicare reassignment Care Compare group NPD Authorized official
• Samantha Ellen Fullmer

  • Family Nurse Practitioner
  • Mesa, AZ
  • NPI 1265031496
  Medicare reassignment Care Compare group NPD
• Shiny Susan Thomas, NP

  • Adult Medicine Physician
  • Mesa, AZ
  • NPI 1558916247
  Medicare reassignment Care Compare group NPD
• Rachael Buckley, NP

  • Family Nurse Practitioner
  • Mesa, AZ
  • NPI 1215479829
  Medicare reassignment NPD
• Tara M Thompson, FNP

  • Family Nurse Practitioner
  • Mesa, AZ
  • NPI 1235652942

  Multi-Specialty

  Medicare reassignment NPD
• Gary E Gawelko Sr., PA-C

  • Medical Physician Assistant
  • Glendale, AZ
  • NPI 1346577244
  Medicare reassignment
• Steven Joel King, PA-C

  • Medical Physician Assistant
  • Chandler, AZ
  • NPI 1629069083
  Medicare reassignment
• Mir Basharat Ali, M.D.

  • Cardiovascular Disease Physician
  • Montebello, CA
  • NPI 1295759694
  NPD
• Yasir Ahmed Batres, MD

  • Cardiovascular Disease Physician
  • Mesa, AZ
  • NPI 1073784724
  NPD (past)
• Fawn Boonstra, RD

  • Registered Dietitian
  • Apache Junction, AZ
  • NPI 1902359771
  NPD (past)
• Saadeh A Saadeh, MD

  • Interventional Cardiology Physician
  • Kingman, AZ
  • NPI 1588685663
  NPD (past)
• Melissa Kay Johnson, NP-C

  • Nurse Practitioner
  • Peoria, IL
  • NPI 1942744495
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712880000000",
    "number": "1861412686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 S GOLD DR STE 5",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "851205036",
            "telephone_number": "480-962-0101",
            "fax_number": "480-962-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7615 E BASELINE RD STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852092000",
            "telephone_number": "480-962-0101",
            "fax_number": "480-962-0202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "99 S Gold Dr Ste 5",
            "address_purpose": "LOCATION",
            "city": "Apache Junction",
            "state": "AZ",
            "postal_code": "851205036",
            "country_code": "US",
            "telephone_number": "480-962-0101 x231",
            "fax_number": "480-962-0202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GOLDFIELD MEDICAL CLINICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A",
        "authorized_official_last_name": "KUMAR",
        "authorized_official_first_name": "SHANTHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-962-0101"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "376592",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "AZ 0742840",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goldfield Cardiovascular Institue",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Goldfield Cardiovascular Institute LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Golden Health at Home Personal Care Services LLC
• Golden Rose Hospice Care Inc
• Golden Years Care Home, LLC
• Golden Years Physical Therapy LLC
• Jeanne Golden
• Goldfield Mountain Healthcare LLC
• Goldfield Mountain Healthcare LLC
• Goldfield Mountain Healthcare LLC
• James M Goldhardt, PA-C
• Craig C Goldman, O.D.

• Cardiovascular Disease Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Cardiovascular Disease Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2024; 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.