NPIMap

Organization Active NPI

Phoenix Spine Goodyear ASC, LLC

  • Ambulatory Surgical Clinic/Center
  • Goodyear, AZ
National Provider Identifier
1891175188
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
OSC7127 Issued in AZ
Legal business name
PHOENIX SPINE GOODYEAR ASC, LLC
Practice address
140 N Litchfield Rd Ste 110
Goodyear, AZ 85338-1226
Phone
(602) 533-2160
Fax
(602) 256-0795
NPI assigned
Jun 2, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Authorized official

Name
Eric Boon
Title
Market President
Phone
(480) 567-0269

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X OSC7127 AZ Primary

Addresses

Primary practice location

140 N Litchfield Rd Ste 110
Goodyear, AZ 85338-1226

Mailing address

140 N Litchfield Rd Ste 110
Goodyear, AZ 85338-1226
Phone (602) 533-2160

Other identifiers 1

IdentifierTypeStateIssuer
987125MedicaidAZ

Other names 2

  • Phoenix Spine Surgery Center Doing business as
  • Arizona Center for Neurosurgery LTD Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180801003783 AZ Part B Supplier - Ambulatory Surgical Center 1557347242 Practice locations: Goodyear, AZ

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Phoenix Spine Goodyear ASC LLC Dba Phoenix Spine Goodyear Ambulatory Surgery CenterCCN 03C0001394
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3300 N Central Ave
Ste 2550
Phoenix, AZ 85012
Phone (602) 456-2525

Practitioners & affiliated clinicians

Practitioners 7

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": "1433203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758499200000",
    "number": "1891175188",
    "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": "602-533-2160",
            "fax_number": "602-532-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 N LITCHFIELD RD STE 110",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853381226",
            "telephone_number": "602-533-2160",
            "fax_number": "602-256-0795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX SPINE GOODYEAR ASC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-02",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A",
        "authorized_official_last_name": "BOON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "MARKET PRESIDENT",
        "authorized_official_telephone_number": "480-567-0269"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "AZ",
            "license": "OSC7127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "987125",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Phoenix Spine Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Arizona Center for Neurosurgery LTD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 22, 2025; 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.