NPIMap

Organization Active NPI

Az BD of Regents for on Behalf of Northern Az University

  • Primary Care Clinic/Center
  • Flagstaff, AZ
National Provider Identifier
1891727863
Registry record updated Aug 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
OTC5149 Issued in AZ
Legal business name
AZ BD OF REGENTS FOR ON BEHALF OF NORTHERN AZ UNIVERSITY
Practice address
824 S San Francisco St
BLDG 25 Northern Arizona University Campus
Flagstaff, AZ 86011-0001
Phone
(928) 523-6343
Fax
(928) 523-5730
NPI assigned
Jul 7, 2006
Last updated
Aug 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2011

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

Authorized official

Name
Dr. John D Haeger, PHD LCSW LCAS RN
Title
President
Phone
(928) 523-6343

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X OTC5149 AZ Primary
Radiology Clinic/Center 261QR0200X 3E115 AZ
Student Health Clinic/Center 261QS1000X NU
Clinical Medical Laboratory 291U00000X 03D0057902 AZ
Community/Retail Pharmacy 3336C0003X Y005336 AZ

Addresses

Primary practice location

824 S San Francisco St
BLDG 25 Northern Arizona University Campus
Flagstaff, AZ 86011-0001

Mailing address

PO Box 6033
Flagstaff, AZ 86011-6033
Phone (928) 523-6343

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100726000284 AZ Part B Supplier - Clinic/Group Practice 0042342115 Receives reassigned benefits from 17 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Flagstaff, AZ

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Northern Arizona University4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

824 S San Francisco St
Flagstaff, AZ 86011
Phone (928) 523-2131

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313366400000",
    "number": "1891727863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6033",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860116033",
            "telephone_number": "928-523-6343",
            "fax_number": "928-523-5730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 S SAN FRANCISCO ST",
            "address_2": "BLDG 25 NORTHERN ARIZONA UNIVERSITY CAMPUS",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860110001",
            "telephone_number": "928-523-6343",
            "fax_number": "928-523-5730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZ BD OF REGENTS FOR ON BEHALF OF NORTHERN AZ UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2011-08-15",
        "status": "A",
        "authorized_official_last_name": "HAEGER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-523-6343",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD  LCSW  LCAS  RN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "OTC5149",
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "AZ",
            "license": "3E115",
            "primary": false
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "03D0057902",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "Y005336",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2011; 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.