NPIMap

Organization Active NPI

Primary Care Medical Group, LLC

  • General Practice Physician
  • Carefree, AZ
National Provider Identifier
1982114385
Registry record updated Oct 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
33789 Issued in AZ
Legal business name
PRIMARY CARE MEDICAL GROUP, LLC
Practice address
36600 N. Pima Road
Ste 307
Carefree, AZ 85377
Phone
(480) 280-5085
NPI assigned
Oct 11, 2017
Last updated
Oct 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2017

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

Authorized official

Name
Kenneth KearnsNPI 1598148223
Title
Owner
Phone
(480) 280-5085

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X 33789 AZ Primary

Addresses

Primary practice location

36600 N. Pima Road
Ste 307
Carefree, AZ 85377

Mailing address

11801 N Tatum Blvd Ste 145
Phoenix, AZ 85028-1613

National Provider Directory

National Provider Directory

Locations

11801 N Tatum Blvd
Ste 145
Phoenix, AZ 85028

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1507680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507680000000",
    "number": "1982114385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11801 N TATUM BLVD STE 145",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850281613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36600 N. PIMA ROAD",
            "address_2": "STE 307",
            "city": "CAREFREE",
            "state": "AZ",
            "postal_code": "85377",
            "telephone_number": "480-280-5085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-11",
        "last_updated": "2017-10-11",
        "status": "A",
        "authorized_official_last_name": "KEARNS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-280-5085"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "AZ",
            "license": "33789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carefree, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.