NPIMap

Organization Active NPI

Southwest Dietitian Group LLC

Doing business as Southwest Dietitian Group

  • Registered Dietitian
  • Gilbert, AZ
National Provider Identifier
1952062275
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
SOUTHWEST DIETITIAN GROUP LLC
Doing business as
Southwest Dietitian Group
Practice address
428 S Gilbert Rd Ste 106-2
Gilbert, AZ 85296-2263
Phone
(602) 218-5278
Fax
(844) 218-4691
NPI assigned
Jan 8, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Authorized official

Name
Maya Elizabeth Nahra, RDNPI 1669798724
Title
President, Owner
Phone
(216) 533-4023

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
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X Primary

Addresses

Primary practice location

428 S Gilbert Rd Ste 106-2
Gilbert, AZ 85296-2263

Mailing address

70 S Val Vista Dr Ste A3-527
Gilbert, AZ 85296-0944
Phone (602) 218-5278

Other practice location 1

323 S Gilbert Rd Ste 105
Gilbert, AZ 85296-1608
Phone (216) 533-4023

Other names 1

  • SOUTHWEST DIETITIAN GROUP Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220224001158 AZ Part B Supplier - Clinic/Group Practice 0749674323 Receives reassigned benefits from 5 practitioners
Practice locations: Gilbert, AZ

National Provider Directory

National Provider Directory

Locations

323 S Gilbert Rd
Ste 105
Gilbert, AZ 85296
Phone (216) 533-4023

21455 S Ellsworth Rd
Ste 36
Queen Creek, AZ 85142
Phone (623) 850-4882

122 E Main St
Medford, OR 97501

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": "1641600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1952062275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 S VAL VISTA DR STE A3-527",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852960944",
            "telephone_number": "602-218-5278",
            "fax_number": "844-218-4691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 S GILBERT RD STE 106-2",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852962263",
            "telephone_number": "602-218-5278",
            "fax_number": "844-218-4691"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "323 S Gilbert Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852961608",
            "country_code": "US",
            "telephone_number": "216-533-4023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHWEST DIETITIAN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-08",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A",
        "authorized_official_last_name": "NAHRA",
        "authorized_official_first_name": "MAYA",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PRESIDENT, OWNER",
        "authorized_official_telephone_number": "216-533-4023",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHWEST DIETITIAN GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOUTHWEST DIETITIAN GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; 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.