NPIMap

Organization Active NPI

Canyon Pain and Spine

  • Durable Medical Equipment & Medical Supplies
  • Gilbert, AZ
National Provider Identifier
1962180844
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
CANYON PAIN AND SPINE
Practice address
1425 S Higley Rd Ste 102
Gilbert, AZ 85296-4798
Phone
(480) 561-5000
Fax
(480) 984-4066
NPI assigned
Jul 10, 2023
Last updated
Jul 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Authorized official

Name
Kirk George Bowden
Title
Owner
Phone
(480) 889-0255

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X
Pain Medicine (Anesthesiology) Physician 207LP2900X
Pain Medicine Physician 208VP0000X
Interventional Pain Medicine Physician 208VP0014X
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

1425 S Higley Rd Ste 102
Gilbert, AZ 85296-4798

Mailing address

1425 S Higley Rd Ste 102
Gilbert, AZ 85296-4798
Phone (480) 561-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260323000945 AZ DME Supplier - Physician - Interventional Pain Management 3870992647 Practice locations: Gilbert, AZ

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1962180844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 S HIGLEY RD STE 102",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852964798",
            "telephone_number": "480-561-5000",
            "fax_number": "480-984-4066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 S HIGLEY RD STE 102",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852964798",
            "telephone_number": "480-561-5000",
            "fax_number": "480-984-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON PAIN AND SPINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "BOWDEN",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-889-0255"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 10, 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.