NPIMap

Organization Active NPI

Sun Life Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Maricopa, AZ
National Provider Identifier
1881073443
Registry record updated Sep 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OTC0187 Issued in AZ
Legal business name
SUN LIFE FAMILY HEALTH CENTER, INC.
Practice address
44765 West Hathaway Ave
Maricopa, AZ 85139-0545
Phone
(520) 568-2245
Fax
(520) 568-2316
NPI assigned
May 28, 2015
Last updated
Sep 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2018

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

Authorized official

Name
Travis Robinette
Title
Chief Executive Officer
Phone
(520) 836-3446

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X OTC0187 AZ Primary

Addresses

Primary practice location

44765 West Hathaway Ave
Maricopa, AZ 85139-0545

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
OTC0187OtherAZLICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205000085 AZ Part B Supplier - Clinic/Group Practice 9335032275 Receives reassigned benefits from 85 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Maricopa, AZ; Oracle, AZ; Mesa, AZ; Florence, AZ; Eloy, AZ; Chandler, AZ; Casa Grande, AZ; Coolidge, AZ

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory

Locations

865 N Arizola Rd
Casa Grande, AZ 85122
Phone (520) 381-0363

Practitioners & affiliated clinicians

Practitioners 90

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.

View all 90

NPI Registry JSON

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

{
    "created_epoch": "1432771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536278400000",
    "number": "1881073443",
    "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": "520-836-8807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44765 WEST HATHAWAY AVE",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851390545",
            "telephone_number": "520-568-2245",
            "fax_number": "520-568-2316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN LIFE FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-28",
        "last_updated": "2018-09-07",
        "status": "A",
        "authorized_official_last_name": "ROBINETTE",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "520-836-3446"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OTC0187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "OTC0187",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maricopa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2018; 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.