Primary Care Medical Group, LLC

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

Organization subpart

No

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

Authorized official

Name

Kenneth Kearns

Title

Owner

Phone

(480) 280-5085

Specialties & licenses 1

Addresses

Locations

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": []
}

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• 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.