| Banner Physician Super Specialists Arizona Llc | |
|
1432 S Dobson Rd Mesa AZ 85202-4768 | |
| (480) 412-4100 | |
| Not Available |
| Full Name | Banner Physician Super Specialists Arizona Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1432 S Dobson Rd, Mesa, Arizona |
| Authorized Official Name and Position | Dennis Laraway (CFO) |
| Authorized Official Contact | 6027474000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Banner Physician Super Specialists Arizona Llc 2901 N Central Ave Ste 160 Phoenix AZ 85012-2702 Ph: () - | Banner Physician Super Specialists Arizona Llc 1432 S Dobson Rd Mesa AZ 85202-4768 Ph: (480) 412-4100 |
| NPI Number | 1841573870 |
|---|---|
| Provider Enumeration Date | 09/26/2011 |
| Last Update Date | 12/28/2021 |
| Medicare PECOS PAC ID | 7911173794 |
|---|---|
| Medicare Enrollment ID | O20111228000353 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841573870 | NPI | - | NPPES |
| 646532 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Peter C Chanin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1497709141 PECOS PAC ID: 4183526569 Enrollment ID: I20040126000248 |
| Provider Name | Kelly L Scoggins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427137157 PECOS PAC ID: 5193718120 Enrollment ID: I20040406000817 |
| Provider Name | Shannon M Forshey |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780775395 PECOS PAC ID: 3577547637 Enrollment ID: I20040616000290 |
| Provider Name | Bonnie K Chiang |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1679542088 PECOS PAC ID: 0648241612 Enrollment ID: I20040803001343 |
| Provider Name | Urszula H Kotlow |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871692178 PECOS PAC ID: 2062481252 Enrollment ID: I20040924000645 |
| Provider Name | Louis P Vu |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1184605859 PECOS PAC ID: 7810966884 Enrollment ID: I20040927000826 |
| Provider Name | Brad Anthony Fiorito |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467415331 PECOS PAC ID: 7618946690 Enrollment ID: I20040927000850 |
| Provider Name | Stuart R Lacey |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831171107 PECOS PAC ID: 0143280586 Enrollment ID: I20041012000248 |
| Provider Name | Bryan M Sandweiss |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467478305 PECOS PAC ID: 7416908157 Enrollment ID: I20050209001093 |
| Provider Name | Thomas L Young |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1285631507 PECOS PAC ID: 7214970532 Enrollment ID: I20050608000152 |
| Provider Name | Joel A Hahnke |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1225094485 PECOS PAC ID: 0042241978 Enrollment ID: I20050830000683 |
| Provider Name | Masayo Watanabe |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1699734434 PECOS PAC ID: 6608842653 Enrollment ID: I20060123000223 |
| Provider Name | Donna C Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346236122 PECOS PAC ID: 6507874427 Enrollment ID: I20060403000776 |
| Provider Name | Roberto R Hayes |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1972557650 PECOS PAC ID: 7810907805 Enrollment ID: I20060508000003 |
| Provider Name | Juan Acosta |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1467423772 PECOS PAC ID: 7517970734 Enrollment ID: I20060711000006 |
| Provider Name | Michael A Young |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356383483 PECOS PAC ID: 3870504830 Enrollment ID: I20060818000405 |
| Provider Name | Merlin C Lowe |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1154383495 PECOS PAC ID: 6406851252 Enrollment ID: I20060928000626 |
| Provider Name | Danthuy N Dao |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215942818 PECOS PAC ID: 8123024379 Enrollment ID: I20061011000074 |
| Provider Name | Pragya Tiwari Sharma |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1164452116 PECOS PAC ID: 7012011810 Enrollment ID: I20070404000311 |
| Provider Name | Emmanuel Katsanis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1720053291 PECOS PAC ID: 2264539121 Enrollment ID: I20070530000066 |
| Provider Name | Jennifer L Matchey |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1194749796 PECOS PAC ID: 8729188628 Enrollment ID: I20070706000280 |
| Provider Name | Barry Chang |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1386612000 PECOS PAC ID: 0446343735 Enrollment ID: I20070831000318 |
| Provider Name | Swati B Kolpuru |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1487789848 PECOS PAC ID: 0042255507 Enrollment ID: I20071126000609 |
| Provider Name | Kristine L Rutt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134328693 PECOS PAC ID: 6901995372 Enrollment ID: I20071207000749 |
| Provider Name | Amy L Ariss-martin |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1710057450 PECOS PAC ID: 5991889990 Enrollment ID: I20080229000273 |
| Provider Name | Philip E Gleason |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1871585810 PECOS PAC ID: 5092610626 Enrollment ID: I20080529000167 |
| Provider Name | Anthony I Ani |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1265619373 PECOS PAC ID: 6709952732 Enrollment ID: I20080827000531 |
| Provider Name | Candice W Yee |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1154565703 PECOS PAC ID: 8224189873 Enrollment ID: I20090622000696 |
| Provider Name | Jonathan I Greenfeld |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1063490191 PECOS PAC ID: 7315042777 Enrollment ID: I20090624000547 |
| Provider Name | Shawn M Singleton |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891991253 PECOS PAC ID: 6901959071 Enrollment ID: I20090806000749 |
| Provider Name | Rachel E Cramton |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932326758 PECOS PAC ID: 6709930639 Enrollment ID: I20090812000325 |
| Provider Name | John H Udall |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1649477357 PECOS PAC ID: 5799839486 Enrollment ID: I20090814000211 |
| Provider Name | Shelly Batra |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1417183542 PECOS PAC ID: 3971658543 Enrollment ID: I20090903000045 |
| Provider Name | Laura B Fleming |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770731507 PECOS PAC ID: 5698803666 Enrollment ID: I20100512000624 |
| Provider Name | Ravindra Kumar Vegunta |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1346280203 PECOS PAC ID: 7012807563 Enrollment ID: I20100528000653 |
| Provider Name | Dale P Woolridge |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508925827 PECOS PAC ID: 8729112172 Enrollment ID: I20100820000131 |
| Provider Name | Leno M Thomas |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1093808370 PECOS PAC ID: 1254332331 Enrollment ID: I20100901000340 |
| Provider Name | Nicholette L Breier Adkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518286210 PECOS PAC ID: 0042335853 Enrollment ID: I20100916001298 |
| Provider Name | Colin P Goggins |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1841480449 PECOS PAC ID: 0648396143 Enrollment ID: I20100921001414 |
| Provider Name | Adebayo O Atolagbe |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891962056 PECOS PAC ID: 5890982110 Enrollment ID: I20101211000125 |
| Provider Name | Lucille K Mcelrath |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801114269 PECOS PAC ID: 6305025578 Enrollment ID: I20110120000932 |
| Provider Name | Casey M Golab |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1790011435 PECOS PAC ID: 1557541067 Enrollment ID: I20110215000697 |
| Provider Name | Zafar Quadir |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1457371759 PECOS PAC ID: 7113943002 Enrollment ID: I20110421000613 |
| Provider Name | Melissa J Assaf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740586593 PECOS PAC ID: 9133304181 Enrollment ID: I20110506000380 |
| Provider Name | Corey D Philpot |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891809240 PECOS PAC ID: 2466414164 Enrollment ID: I20110526000165 |
| Provider Name | Alan S Graham |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1598771099 PECOS PAC ID: 7810962354 Enrollment ID: I20110720000840 |
| Provider Name | Tamara Zach |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1962638254 PECOS PAC ID: 5799823480 Enrollment ID: I20110722000715 |
| Provider Name | Janelle L Vesely |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235394867 PECOS PAC ID: 6901076629 Enrollment ID: I20110906000699 |
| Provider Name | Sarah S Bannister |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1588828032 PECOS PAC ID: 0648440396 Enrollment ID: I20110907001037 |
| Provider Name | Suzanne M Yoder |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1083836589 PECOS PAC ID: 3375636582 Enrollment ID: I20120410000272 |
| Provider Name | Uchenna G Onyia |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1346482031 PECOS PAC ID: 1052574316 Enrollment ID: I20120523000692 |
| Provider Name | Thomas T Hui |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1487725206 PECOS PAC ID: 7618992223 Enrollment ID: I20120719000632 |
| Provider Name | Wendy Su |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1609807064 PECOS PAC ID: 3476653148 Enrollment ID: I20120803000139 |
| Provider Name | Ami Jo Long |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1750643417 PECOS PAC ID: 4183870223 Enrollment ID: I20120806000816 |
| Provider Name | Melanie A Nugent |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003162108 PECOS PAC ID: 7517116965 Enrollment ID: I20121001000039 |
| Provider Name | Russell Horton |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780996967 PECOS PAC ID: 9537308663 Enrollment ID: I20130620000196 |
| Provider Name | Rachel M Haake |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1538385265 PECOS PAC ID: 9032304258 Enrollment ID: I20130813000116 |
| Provider Name | Crystal M Vegh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770923872 PECOS PAC ID: 6305089863 Enrollment ID: I20130830000718 |
| Provider Name | David J Aria |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477794253 PECOS PAC ID: 2062655327 Enrollment ID: I20130905000662 |
| Provider Name | Dennise A Reyes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497060768 PECOS PAC ID: 3274777891 Enrollment ID: I20130923000396 |
| Provider Name | Wayne Truong |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1033544564 PECOS PAC ID: 7113151549 Enrollment ID: I20131017001665 |
| Provider Name | Lindsey N Weak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326472150 PECOS PAC ID: 5698900967 Enrollment ID: I20131023001145 |
| Provider Name | Marek Lukacik |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1225170780 PECOS PAC ID: 2961508965 Enrollment ID: I20140121000841 |
| Provider Name | Daniel Allen Combs |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1235427345 PECOS PAC ID: 7214150267 Enrollment ID: I20140521000784 |
| Provider Name | Kim E Garay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952556599 PECOS PAC ID: 7618190471 Enrollment ID: I20140523000020 |
| Provider Name | Ryan Miller |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1548421258 PECOS PAC ID: 3779708375 Enrollment ID: I20140715000424 |
| Provider Name | Smita N Aguirre |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1144644733 PECOS PAC ID: 2466670104 Enrollment ID: I20140821002294 |
| Provider Name | Vinay Bandla |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1710134762 PECOS PAC ID: 5294953550 Enrollment ID: I20140827003023 |
| Provider Name | An Tran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487880076 PECOS PAC ID: 4385865963 Enrollment ID: I20141023001702 |
| Provider Name | Randall Fortuna |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1285607986 PECOS PAC ID: 6406810076 Enrollment ID: I20141030000024 |
| Provider Name | John H Udall |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1649477357 PECOS PAC ID: 5799839486 Enrollment ID: I20150131000177 |
| Provider Name | Hiep T Nguyen |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1962480616 PECOS PAC ID: 4688638828 Enrollment ID: I20150601002311 |
| Provider Name | Unni Krishna Kaimal Udayasankar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1568647253 PECOS PAC ID: 6800927617 Enrollment ID: I20150709003119 |
| Provider Name | Rahul Bhatia |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1508854563 PECOS PAC ID: 3375620115 Enrollment ID: I20150727002506 |
| Provider Name | Eric M Peters |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1760619159 PECOS PAC ID: 3678887940 Enrollment ID: I20150730011778 |
| Provider Name | Ahmad Ghazi-askar |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912281056 PECOS PAC ID: 2567778152 Enrollment ID: I20150827000777 |
| Provider Name | Maria S Chico |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912958315 PECOS PAC ID: 5698749992 Enrollment ID: I20150911001310 |
| Provider Name | Husam Srour Srour Mallah |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1912048703 PECOS PAC ID: 8325232432 Enrollment ID: I20150915002009 |
| Provider Name | Ariella A Friedman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1750542346 PECOS PAC ID: 9436371853 Enrollment ID: I20150924001635 |
| Provider Name | Daniel E Miga |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1063455178 PECOS PAC ID: 3173799962 Enrollment ID: I20151021000802 |
| Provider Name | Satya S Vittala |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1669760468 PECOS PAC ID: 9537391453 Enrollment ID: I20151125000527 |
| Provider Name | Renae B Merz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134591035 PECOS PAC ID: 4284934076 Enrollment ID: I20151201000564 |
| Provider Name | Rahel Zubairi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1871535088 PECOS PAC ID: 7719940006 Enrollment ID: I20151231001355 |
| Provider Name | Jason Scott Couch |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1093009672 PECOS PAC ID: 9234357070 Enrollment ID: I20160203002978 |
| Provider Name | David Y Moromisato |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1386771707 PECOS PAC ID: 0042346322 Enrollment ID: I20160209002592 |
| Provider Name | Yuki Yasaka |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1033588959 PECOS PAC ID: 7517263585 Enrollment ID: I20160317001008 |
| Provider Name | Rachel L Calendo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669586301 PECOS PAC ID: 1557669769 Enrollment ID: I20160420002110 |
| Provider Name | Mary Jane T Barth |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1376509281 PECOS PAC ID: 3072523968 Enrollment ID: I20160425000986 |
| Provider Name | Gordon A Cohen |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1629168513 PECOS PAC ID: 4688643505 Enrollment ID: I20160623001855 |
| Provider Name | Ashley Pearl Gray-zlotnick |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1134461346 PECOS PAC ID: 4082909064 Enrollment ID: I20160830001945 |
| Provider Name | Mark Jason Weiss |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1154663623 PECOS PAC ID: 4385931088 Enrollment ID: I20160923000842 |
| Provider Name | Janina J Carter |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1164977955 PECOS PAC ID: 3971890161 Enrollment ID: I20161003002216 |
| Provider Name | Vidya Surapaneni |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1851521785 PECOS PAC ID: 9931488210 Enrollment ID: I20161108002644 |
| Provider Name | Santosh S Hanmod |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1730337478 PECOS PAC ID: 9335462811 Enrollment ID: I20161128001905 |
| Provider Name | Annette R Lopez |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1699086256 PECOS PAC ID: 6608158829 Enrollment ID: I20170124001762 |
| Provider Name | Rahul K Chawla |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1548201189 PECOS PAC ID: 8729082011 Enrollment ID: I20170130002738 |
| Provider Name | Ashley G Tian |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1114107844 PECOS PAC ID: 7719127505 Enrollment ID: I20170323000025 |
| Provider Name | Srinivas Dannaram |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003120437 PECOS PAC ID: 5698908564 Enrollment ID: I20170523002018 |
| Provider Name | Prasad S Ravi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1730461120 PECOS PAC ID: 1456635150 Enrollment ID: I20170616001165 |
| Provider Name | Deepa Prasad |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1174838528 PECOS PAC ID: 3870751886 Enrollment ID: I20170619000662 |
| Provider Name | Shwetal P Lalan |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1912210907 PECOS PAC ID: 5496024481 Enrollment ID: I20170706003181 |
| Provider Name | Naresh Reddivalla |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1073851150 PECOS PAC ID: 8628367711 Enrollment ID: I20170718001431 |
| Provider Name | Roshan Raja |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1639257264 PECOS PAC ID: 1850334285 Enrollment ID: I20170821003349 |
| Provider Name | Michelina C De La Maza |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1255779385 PECOS PAC ID: 7012280852 Enrollment ID: I20170830001672 |
| Provider Name | Sarah C Karabatsos |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457750416 PECOS PAC ID: 9739497066 Enrollment ID: I20180212000126 |
| Provider Name | Christina Woods |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992204051 PECOS PAC ID: 0345502217 Enrollment ID: I20180313002437 |
| Provider Name | Ryan M Stewart |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659768240 PECOS PAC ID: 5991052433 Enrollment ID: I20180716001498 |
| Provider Name | Georgia Androutsopoulou |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1518207687 PECOS PAC ID: 2860759289 Enrollment ID: I20180718002880 |
| Provider Name | Anil V Gajare |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1518245828 PECOS PAC ID: 3577720515 Enrollment ID: I20180801001289 |
| Provider Name | Rimah Sharief |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1467891283 PECOS PAC ID: 9931457637 Enrollment ID: I20180810002404 |
| Provider Name | Fatma Hanif |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1063805158 PECOS PAC ID: 8628321924 Enrollment ID: I20181105000507 |
| Provider Name | Helayne Rachel Feferman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1043577083 PECOS PAC ID: 7012208986 Enrollment ID: I20181105002759 |
| Provider Name | Pablo Andres Angulo |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1902122120 PECOS PAC ID: 1658660790 Enrollment ID: I20190222002572 |
| Provider Name | Shubhangi Shahaji Peche |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1063681336 PECOS PAC ID: 2769639756 Enrollment ID: I20190517002161 |
| Provider Name | Jessica Randall Morgan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801243258 PECOS PAC ID: 7517290513 Enrollment ID: I20190606000751 |
| Provider Name | Shane Rainey |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1588041164 PECOS PAC ID: 4688989304 Enrollment ID: I20190712002499 |
| Provider Name | Monica Margaret Davini |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1952643348 PECOS PAC ID: 8123355237 Enrollment ID: I20190813001269 |
| Provider Name | Amy Zangger Eby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982825436 PECOS PAC ID: 9133457302 Enrollment ID: I20190826003216 |
| Provider Name | Thomas Cramer Lee |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1275620353 PECOS PAC ID: 6103984232 Enrollment ID: I20190828002377 |
| Provider Name | Misty Villar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831742618 PECOS PAC ID: 2961731526 Enrollment ID: I20190906000756 |
| Provider Name | Sara Michelle York |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1306290101 PECOS PAC ID: 2062741069 Enrollment ID: I20190916002742 |
| Provider Name | Lee Stuart Rusakow |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1710973532 PECOS PAC ID: 9335153709 Enrollment ID: I20190918003441 |
| Provider Name | Joseph Torkildson |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1710944095 PECOS PAC ID: 7911959499 Enrollment ID: I20190919000152 |
| Provider Name | Jane Lyons |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1407117039 PECOS PAC ID: 0042511164 Enrollment ID: I20191025001806 |
| Provider Name | Kyung Chung |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1821208240 PECOS PAC ID: 0648529586 Enrollment ID: I20191104003053 |
| Provider Name | Anna Sandstrom |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1043382856 PECOS PAC ID: 6204912934 Enrollment ID: I20191210003476 |
| Provider Name | Julie S Lammers |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1093186868 PECOS PAC ID: 8123452489 Enrollment ID: I20191220000176 |
| Provider Name | Emmanuel Katsanis |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1720053291 PECOS PAC ID: 2264539121 Enrollment ID: I20191231000481 |
| Provider Name | Laurel Christine Truscott |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1730421579 PECOS PAC ID: 7911271267 Enrollment ID: I20200323001179 |
| Provider Name | Graham C. Sawicki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477103455 PECOS PAC ID: 1355770561 Enrollment ID: I20200408003173 |
| Provider Name | Soumya Nagaraja |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1316353873 PECOS PAC ID: 4082036447 Enrollment ID: I20200612001854 |
| Provider Name | Matthew Morin |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1841605086 PECOS PAC ID: 6507180783 Enrollment ID: I20200827000697 |
| Provider Name | Nadeem Shabbir |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1538124391 PECOS PAC ID: 5092794834 Enrollment ID: I20200903000363 |
| Provider Name | Clemente Morales |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1801409032 PECOS PAC ID: 6709204126 Enrollment ID: I20200917001015 |
| Provider Name | Maya S Stamm |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1750735346 PECOS PAC ID: 0941574305 Enrollment ID: I20200928002866 |
| Provider Name | Kristen S Yee |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1346225992 PECOS PAC ID: 0143324004 Enrollment ID: I20201007003447 |
| Provider Name | Ruchi J. Patel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043645450 PECOS PAC ID: 6800216813 Enrollment ID: I20201013002046 |
| Provider Name | Jennifer Zak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689262040 PECOS PAC ID: 5698181212 Enrollment ID: I20210305002068 |
| Provider Name | David Kukafka |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1255301180 PECOS PAC ID: 3072573492 Enrollment ID: I20210505001930 |
| Provider Name | Sarah Anna Lau-braunhut |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1184010464 PECOS PAC ID: 9335494004 Enrollment ID: I20210721001618 |
| Provider Name | Christopher J Schmehil |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1023499936 PECOS PAC ID: 5496060691 Enrollment ID: I20210809002345 |
| Provider Name | Savannah Apodaca |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275050270 PECOS PAC ID: 9032473756 Enrollment ID: I20210817001704 |
| Provider Name | Samita Khara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487224382 PECOS PAC ID: 8527464023 Enrollment ID: I20210909000143 |
| Provider Name | Amit Chandra Misra |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1104060102 PECOS PAC ID: 2668750175 Enrollment ID: I20210916001686 |
| Provider Name | Celia Zebrack |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1396968111 PECOS PAC ID: 2264591536 Enrollment ID: I20211013000874 |
| Provider Name | Julia Gray Farber |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356873996 PECOS PAC ID: 1557752995 Enrollment ID: I20211220001650 |
| Provider Name | Nikita G. Alexiades |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1548603053 PECOS PAC ID: 6800210485 Enrollment ID: I20220131000565 |
| Provider Name | Joshua Wood |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1649561994 PECOS PAC ID: 9436395464 Enrollment ID: I20220323002721 |
| Provider Name | Dayana Marlen Dominguez Batista |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1245735026 PECOS PAC ID: 8628325644 Enrollment ID: I20220708001106 |
| Provider Name | Andrew R. Valenzuela |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1851889232 PECOS PAC ID: 2365822269 Enrollment ID: I20220709000604 |
| Provider Name | Jonathan E Mandabach |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912386392 PECOS PAC ID: 1153660519 Enrollment ID: I20220717000020 |
| Provider Name | Lauren Nicole Simpson |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1497199681 PECOS PAC ID: 4587891064 Enrollment ID: I20220817001306 |
| Provider Name | Alisha E Moreno |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1588026132 PECOS PAC ID: 8628499886 Enrollment ID: I20221004002202 |
| Provider Name | Neelima K Marupudi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1265775159 PECOS PAC ID: 2466743661 Enrollment ID: I20221026000273 |
| Provider Name | Diana Elizabeth Drogalis-kim |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1194041749 PECOS PAC ID: 6103065057 Enrollment ID: I20230116000571 |
| Provider Name | Shabana Jawed Jessani |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1437277795 PECOS PAC ID: 7416320981 Enrollment ID: I20230302002953 |
| Provider Name | Deric H Nye |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1699014464 PECOS PAC ID: 2769711258 Enrollment ID: I20230728003012 |
| Provider Name | Gary J King |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1659720704 PECOS PAC ID: 9739472622 Enrollment ID: I20230814000988 |
| Provider Name | Megan Maureen Schicktanz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932737111 PECOS PAC ID: 3476970997 Enrollment ID: I20230908001560 |
| Provider Name | Kelly S Tieves |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1598716243 PECOS PAC ID: 4789681479 Enrollment ID: I20230926002734 |
| Provider Name | Katherine Marie Rodriguez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1376072462 PECOS PAC ID: 7416304134 Enrollment ID: I20231116002800 |
| Provider Name | Alexis Smith |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1093974974 PECOS PAC ID: 3375818099 Enrollment ID: I20240104004856 |
| Provider Name | Judith Ming-hai Wong |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1457500738 PECOS PAC ID: 4880832468 Enrollment ID: I20240216004109 |
| Provider Name | L R Scherer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1154391142 PECOS PAC ID: 8729092176 Enrollment ID: I20240422001658 |
Ohana Kids & Family Kare Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3130 E Baseline Rd Ste 103, Mesa, AZ 85204 Phone: 480-539-7618 Fax: 480-900-8884 | |
True Patriot Consulting, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1134 E University Dr Ste 111, Mesa, AZ 85203 Phone: 480-398-1220 Fax: 480-398-1238 | |
M.g.t Rn Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7117 E Peralta Cir, Mesa, AZ 85212 Phone: 480-430-0721 | |
Stillpoint Wellness, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2266 S Dobson Rd Ste 200, Mesa, AZ 85202 Phone: 480-280-1996 Fax: 602-532-7649 | |
Cactus Pediatric Orthopaedics, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1500 S Dobson Rd Ste 200, Mesa, AZ 85202 Phone: 480-551-0300 | |
Voyage Medical Primary Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1130 W Grove Ave Ste 115, Mesa, AZ 85210 Phone: 480-685-0930 | |
Tripp Family Medicine, P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2830 E Brown Rd, Suite 1, Mesa, AZ 85213 Phone: 480-830-7546 Fax: 480-830-7550 |