NPIMap

Organization Active NPI

Trident Clinical PLLC

  • Primary Care Clinic/Center
  • Peoria, AZ
National Provider Identifier
1902204191
Registry record updated Oct 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
40752 Issued in AZ
Legal business name
TRIDENT CLINICAL PLLC
Practice address
20340 N Lake Pleasant Rd Ste 109
Peoria, AZ 85382-9713
Phone
(623) 299-9988
NPI assigned
Dec 20, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2016

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

Authorized official

Name
Dr. Arvind Mahadevan, M.D.NPI 1114199148
Title
Medical Director
Phone
(480) 241-2034

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 40752 AZ Primary

Addresses

Primary practice location

20340 N Lake Pleasant Rd Ste 109
Peoria, AZ 85382-9713

Mailing address

20340 N Lake Pleasant Rd
Suite 109
Peoria, AZ 85382-9714
Phone (623) 299-9988

Other names 1

  • TRIDENT HEALTH CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211001001983 AZ Part B Supplier - Clinic/Group Practice 7719260389 Receives reassigned benefits from 6 practitioners
Practice locations: Peoria, AZ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2094842Trident Health Center20340 N Lake Pleasant Rd, Ste 109, Peoria, AZ 85382Certificate of waiverApr 23, 2027

National Provider Directory

National Provider Directory

Locations

20340 N Lake Pleasant Rd
Ste 119
Peoria, AZ 85382

20340 N Lake Pleasant Rd
Ste 1
Peoria, AZ 85382

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10368/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 8

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": "1419033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477526400000",
    "number": "1902204191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20340 N LAKE PLEASANT RD",
            "address_2": "SUITE 109",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853829714",
            "telephone_number": "623-299-9988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20340 N LAKE PLEASANT RD STE 109",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853829713",
            "telephone_number": "623-299-9988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIDENT CLINICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-20",
        "last_updated": "2016-10-27",
        "status": "A",
        "authorized_official_last_name": "MAHADEVAN",
        "authorized_official_first_name": "ARVIND",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "480-241-2034",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "40752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRIDENT HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; 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.