Active NPI
Canyon Pain Surgery Center
- Ambulatory Surgical Clinic/Center
- Mesa, AZ
National Provider Identifier
1972217180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- Legal business name
- CANYON PAIN SURGERY CENTER
- Practice address
- 4540 E Baseline Rd Ste 117
Mesa, AZ 85206-4617 - Phone
- (480) 561-0446
- Fax
- (480) 608-4762
- NPI assigned
- Jan 11, 2023
- Last updated
- Aug 27, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jody Smith
- Title
- Administrator
- Phone
- (480) 565-5925
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Primary |
Addresses
Primary practice location
4540 E Baseline Rd Ste 117
Mesa, AZ 85206-4617
Mailing address
4540 E Baseline Rd Ste 117
Mesa, AZ 85206-4617
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
Care Compare: Ambulatory surgical center
Medicare Care Compare- Listed as
- Canyon Pain Surgery Center LLC
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- Canyon Pain Surgery Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Anesthesiology Physician
- Mesa, AZ
- NPI 1245054816
Practitioners & affiliated clinicians
Practitioners 4
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.
-
- Pain Medicine (Anesthesiology) Physician
- Mesa, AZ
- NPI 1255592994
-
- Pain Medicine Physician
- Gilbert, AZ
- NPI 1326366832
-
- Certified Registered Nurse Anesthetist
- Chandler, AZ
- NPI 1083093868
-
- Certified Registered Nurse Anesthetist
- Phoenix, AZ
- NPI 1265616395
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1673395200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1724716800000",
"number": "1972217180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4540 E BASELINE RD STE 117",
"city": "MESA",
"state": "AZ",
"postal_code": "852064617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4540 E BASELINE RD STE 117",
"city": "MESA",
"state": "AZ",
"postal_code": "852064617",
"telephone_number": "480-561-0446",
"fax_number": "480-608-4762"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CANYON PAIN SURGERY CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2023-01-11",
"last_updated": "2024-08-27",
"certification_date": "2024-08-27",
"status": "A",
"authorized_official_last_name": "SMITH",
"authorized_official_first_name": "JODY",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "480-565-5925"
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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.