NPIMap

Organization Active NPI

Estrella Pkwy Medical Center, LLC.

  • Medical Physician Assistant
  • Goodyear, AZ
National Provider Identifier
1871546036
Registry record updated Apr 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
3789 Issued in AZ
Legal business name
ESTRELLA PKWY MEDICAL CENTER, LLC.
Practice address
530 N Estrella Pkwy
Ste. C-1
Goodyear, AZ 85338-4137
Phone
(623) 932-9211
Fax
(623) 932-9210
NPI assigned
May 18, 2006
Last updated
Apr 12, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2017

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

Authorized official

Name
Brion David MuscarellaNPI 1043264187
Title
President
Phone
(623) 932-9211

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 7681 AZ
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X 3789 AZ Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X AP3364 AZ

Addresses

Primary practice location

530 N Estrella Pkwy
Ste. C-1
Goodyear, AZ 85338-4137

Mailing address

530 N Estrella Pkwy
Ste. C-1
Goodyear, AZ 85338-4137
Phone (623) 932-9211

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121113000144 AZ Part B Supplier - Clinic/Group Practice 6002067410 Receives reassigned benefits from 10 practitioners
Practice locations: Goodyear, AZ
O20160219002194 AZ DME Supplier - Medical Supply Company 6002067410 Practice locations: Goodyear, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491955200000",
    "number": "1871546036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 N ESTRELLA PKWY",
            "address_2": "STE. C-1",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853384137",
            "telephone_number": "623-932-9211",
            "fax_number": "623-932-9210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 N ESTRELLA PKWY",
            "address_2": "STE. C-1",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853384137",
            "telephone_number": "623-932-9211",
            "fax_number": "623-932-9210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESTRELLA PKWY MEDICAL CENTER, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2017-04-12",
        "status": "A",
        "authorized_official_last_name": "MUSCARELLA",
        "authorized_official_first_name": "BRION",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "623-932-9211"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "7681",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "3789",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "AP3364",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; 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.