Organization Active NPI

Ramon C Pascua MD PLLC

  • Family Medicine Physician
  • Glendale, AZ
National Provider Identifier
1952352585
Registry record updated Nov 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
24918 Issued in AZ
Legal business name
RAMON C PASCUA MD PLLC
Practice address
17100 N 67TH Ave
Building 5, Suite 502
Glendale, AZ 85308-3605
Phone
(623) 466-6339
Fax
(623) 466-6338
NPI assigned
May 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2010

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

Authorized official

Name
Ramon Pascua, MDNPI 1629027248
Title
President Owner
Phone
(623) 466-6339

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 24918 AZ Primary

Addresses

Primary practice location

17100 N 67TH Ave
Building 5, Suite 502
Glendale, AZ 85308-3605

Mailing address

17100 N 67TH Ave
Building 5, Suite 502
Glendale, AZ 85308-3605
Phone (623) 466-6339

Other identifiers 1

IdentifierTypeStateIssuer
374067MedicaidAZ

Other names 1

  • NORTHWEST FAMILY CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060605000219 AZ Part B Supplier - Clinic/Group Practice 9931110079 Receives reassigned benefits from 1 practitioner
Practice locations: Glendale, 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
03D1067764Northwest Family Clinic17100 N 67TH Ave, BLDG 5, Ste 502, Glendale, AZ 85308Certificate of waiverApr 24, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288915200000",
    "number": "1952352585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17100 N 67TH AVE",
            "address_2": "BUILDING 5, SUITE 502",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853083605",
            "telephone_number": "623-466-6339",
            "fax_number": "623-466-6338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17100 N 67TH AVE",
            "address_2": "BUILDING 5, SUITE 502",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853083605",
            "telephone_number": "623-466-6339",
            "fax_number": "623-466-6338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAMON C PASCUA MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2010-11-05",
        "status": "A",
        "authorized_official_last_name": "PASCUA",
        "authorized_official_first_name": "RAMON",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "623-466-6339",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "24918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "374067",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHWEST FAMILY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2010; 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.