NPIMap

Organization Active NPI

Phoenix Spine Goodyear ASC, LLC

  • Neurological Surgery Physician
  • Goodyear, AZ
National Provider Identifier
1871667014
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
28519 Issued in AZ
Legal business name
PHOENIX SPINE GOODYEAR ASC, LLC
Practice address
140 N Litchfield Rd
Suite 110
Goodyear, AZ 85338-1277
Phone
(602) 256-2525
Fax
(602) 256-0795
NPI assigned
Nov 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Authorized official

Name
Eric Boon
Title
Ao
Phone
(480) 567-0269

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X 28519 AZ Primary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X 35838 AZ

Addresses

Primary practice location

140 N Litchfield Rd
Suite 110
Goodyear, AZ 85338-1277

Mailing address

140 N Litchfield Rd Ste 110
Goodyear, AZ 85338-1226
Phone (602) 256-2525

Other identifiers 1

IdentifierTypeStateIssuer
987125MedicaidAZ

Other names 1

  • Phoenix Spine Goodyear ASC, LLC Doing business as

National Provider Directory

National Provider Directory

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": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1871667014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 N LITCHFIELD RD STE 110",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853381226",
            "telephone_number": "602-256-2525",
            "fax_number": "602-256-0795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 N LITCHFIELD RD",
            "address_2": "SUITE 110",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853381277",
            "telephone_number": "602-256-2525",
            "fax_number": "602-256-0795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX SPINE GOODYEAR ASC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "BOON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "480-567-0269"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "AZ",
            "license": "28519",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "AZ",
            "license": "35838",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "987125",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Spine Goodyear ASC, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.