| Banner Alzheimer's Institute | |
|
901 E Willetta St Phoenix AZ 85006-2727 | |
| (602) 239-6967 | |
| (602) 239-6253 |
| Full Name | Banner Alzheimer's Institute |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 901 E Willetta St, Phoenix, Arizona |
| Authorized Official Name and Position | Eric Reiman (CEO/CSO) |
| Authorized Official Contact | 6027474000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Banner Alzheimer's Institute 2901 N Central Ave Ste 160 Phoenix AZ 85012-2702 Ph: () - | Banner Alzheimer's Institute 901 E Willetta St Phoenix AZ 85006-2727 Ph: (602) 239-6967 |
| NPI Number | 1013966712 |
|---|---|
| Provider Enumeration Date | 05/09/2006 |
| Last Update Date | 10/25/2024 |
| Certification Date | 10/25/2024 |
| Medicare PECOS PAC ID | 8527070101 |
|---|---|
| Medicare Enrollment ID | O20060623000043 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013966712 | NPI | - | NPPES |
| 092207 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Mary Lou Hernandez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083668388 PECOS PAC ID: 4789632506 Enrollment ID: I20050108000160 |
| Provider Name | Michele M Grigaitis-reyes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497862379 PECOS PAC ID: 2466435128 Enrollment ID: I20050316000189 |
| Provider Name | David A Weidman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1467447656 PECOS PAC ID: 8628054277 Enrollment ID: I20051101000417 |
| Provider Name | Gamal F Sidarous |
|---|---|
| Provider Type | Practitioner - Nuclear Medicine |
| Provider Identifiers | NPI Number: 1699731802 PECOS PAC ID: 0042220063 Enrollment ID: I20060504000327 |
| Provider Name | Scott J Sherman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265486179 PECOS PAC ID: 8628089000 Enrollment ID: I20060523000146 |
| Provider Name | Pierre N Tariot |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1568429025 PECOS PAC ID: 8921025321 Enrollment ID: I20060626000278 |
| Provider Name | Peter J Sunenshine |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1487610937 PECOS PAC ID: 0749238848 Enrollment ID: I20060828000404 |
| Provider Name | Esther M Pineda |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962515163 PECOS PAC ID: 8820189335 Enrollment ID: I20070813000035 |
| Provider Name | Christine M Belden |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821297367 PECOS PAC ID: 9032291976 Enrollment ID: I20080130000595 |
| Provider Name | Georg A Hishaw |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1275734493 PECOS PAC ID: 9133293384 Enrollment ID: I20080806000069 |
| Provider Name | Sudeshna C Bose |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1962414839 PECOS PAC ID: 1153480454 Enrollment ID: I20081031000120 |
| Provider Name | Allison Perrin |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1992929624 PECOS PAC ID: 2264401389 Enrollment ID: I20081120000060 |
| Provider Name | Rishi K Gosalia |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174797286 PECOS PAC ID: 8820149511 Enrollment ID: I20090618000726 |
| Provider Name | Lori E Nisson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255562385 PECOS PAC ID: 6103964820 Enrollment ID: I20091117000311 |
| Provider Name | Sara S Dhanani |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1063614873 PECOS PAC ID: 3577704550 Enrollment ID: I20130802000677 |
| Provider Name | Cheryl A Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477998508 PECOS PAC ID: 7618104456 Enrollment ID: I20131226000415 |
| Provider Name | Matthew T Malone |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912952136 PECOS PAC ID: 8426036625 Enrollment ID: I20150129002307 |
| Provider Name | Marina Mary Reade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124460795 PECOS PAC ID: 3476878851 Enrollment ID: I20150205001300 |
| Provider Name | Jacquelynn N Copeland |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1215322847 PECOS PAC ID: 7012225543 Enrollment ID: I20151002002293 |
| Provider Name | David R Shprecher |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1679692594 PECOS PAC ID: 0648365650 Enrollment ID: I20151119002780 |
| Provider Name | Kathryn E Bradley |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1073834362 PECOS PAC ID: 6608093653 Enrollment ID: I20160118000362 |
| Provider Name | Emily E Borchers |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1093181273 PECOS PAC ID: 5092002915 Enrollment ID: I20160921000421 |
| Provider Name | Tessa Sweepe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417405226 PECOS PAC ID: 4688942139 Enrollment ID: I20170626000495 |
| Provider Name | Michelle C James |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841702743 PECOS PAC ID: 8921366535 Enrollment ID: I20180102002535 |
| Provider Name | Dev Ashish |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396256251 PECOS PAC ID: 0547528168 Enrollment ID: I20180102002679 |
| Provider Name | Steven Z Rapcsak |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1659474039 PECOS PAC ID: 8022378231 Enrollment ID: I20180208001556 |
| Provider Name | Ganesh Gopalakrishna |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891995262 PECOS PAC ID: 4183893951 Enrollment ID: I20180720002520 |
| Provider Name | Briana J Auman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437506490 PECOS PAC ID: 6406144724 Enrollment ID: I20180913003357 |
| Provider Name | Melissa Mg Cardenas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982103586 PECOS PAC ID: 2264784453 Enrollment ID: I20181017000837 |
| Provider Name | Alireza Atri |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326038506 PECOS PAC ID: 7911084330 Enrollment ID: I20181109002542 |
| Provider Name | Po-heng Tsai |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1952532475 PECOS PAC ID: 9032380993 Enrollment ID: I20190214003190 |
| Provider Name | Barbara A Klauser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528474350 PECOS PAC ID: 2860732542 Enrollment ID: I20190315000326 |
| Provider Name | Michelle Marie Faddoul |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548541253 PECOS PAC ID: 5294065231 Enrollment ID: I20190918000993 |
| Provider Name | Stephanie Dianne De Santiago |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497303028 PECOS PAC ID: 1658602081 Enrollment ID: I20191015003617 |
| Provider Name | Allan A Anderson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083670517 PECOS PAC ID: 5890776991 Enrollment ID: I20200207002266 |
| Provider Name | Victoria Lindsay Cannon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174815419 PECOS PAC ID: 0941630248 Enrollment ID: I20200429002304 |
| Provider Name | Jeremy Pruzin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1962816249 PECOS PAC ID: 0042501090 Enrollment ID: I20200923001175 |
| Provider Name | Debra Witthar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760090427 PECOS PAC ID: 6507286788 Enrollment ID: I20201009001796 |
| Provider Name | Parichita Choudhury |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1598318677 PECOS PAC ID: 5890021786 Enrollment ID: I20201208000933 |
| Provider Name | Michaela Ann Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700368685 PECOS PAC ID: 3274935622 Enrollment ID: I20210708001180 |
| Provider Name | Pallavi Joshi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1750765442 PECOS PAC ID: 1759626260 Enrollment ID: I20210824002750 |
| Provider Name | Alexander Choi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1902238173 PECOS PAC ID: 6406193556 Enrollment ID: I20210902003011 |
| Provider Name | Jaclyn M Robinson |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1609302249 PECOS PAC ID: 6406279223 Enrollment ID: I20211015002406 |
| Provider Name | Emily Edmonds |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780120287 PECOS PAC ID: 7911284351 Enrollment ID: I20220103000813 |
| Provider Name | Gerrie Lynn Jakobs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942946322 PECOS PAC ID: 8921482126 Enrollment ID: I20220908000009 |
| Provider Name | Lauren Perry Blake |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912640046 PECOS PAC ID: 4385029743 Enrollment ID: I20220921001063 |
| Provider Name | Sarah Elizabeth Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700336724 PECOS PAC ID: 6901180884 Enrollment ID: I20230802002795 |
| Provider Name | Dayra A Valentino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063292365 PECOS PAC ID: 6507213337 Enrollment ID: I20231115002631 |
| Provider Name | Carrie Langford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558137422 PECOS PAC ID: 1153771399 Enrollment ID: I20231229001230 |
| Provider Name | Jennifer Haller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457129256 PECOS PAC ID: 5193160877 Enrollment ID: I20240304003738 |
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