BANNER -- UNIVERSITY MEDICAL GROUP (NPI# 1508809427) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508809427 |
| Entity Type | Organization |
| Organization Name | BANNER -- UNIVERSITY MEDICAL GROUP |
| Other Organization Name | UNIVERSITY PHYSICIANS, INC. |
| Practice Address |
2901 N Central Ave Phoenix AZ 85012-2700 |
| Practice Telephone | 6027474000 |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2016-02-08 |
| Authorized Official Name | DENNIS DAHLEN (SR VP FINANCE) |
| Authorized Official Telephone | 6027474000 |
| Is Organization Subpart | Y |
| Parent Organization Name | BANNER HEALTH |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207K00000X | Allergy & Immunology | Allopathic & Osteopathic Physicians | ||
| N | 207L00000X | Anesthesiology | Allopathic & Osteopathic Physicians | ||
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| N | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207U00000X | Nuclear Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 207W00000X | Ophthalmology | Allopathic & Osteopathic Physicians | ||
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
AZ | Ambulatory Health Care Facilities | |
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | RAIL ROAD MEDICARE | CC6470 | 01 |
| AZ | 005638 | 05 |
| Other Name | Type Code |
|---|---|
| University Physicians, Inc. | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932708328 | Banner -- University Medical Group | Clinic/Center | 535 N Wilmot Rd Ste 101, Tucson, AZ 85711-2683 | 2020-10-18 |
| 1578910485 | Banner -- University Medical Group | Clinic/Center | 535 N Wilmot Rd, Tucson, AZ 85711-2600 | 2016-05-20 |
| 1568818649 | Banner -- University Medical Group | Clinic/Center | 535 N Wilmot Rd, Tucson, AZ 85711-2600 | 2016-05-09 |
| Street Address |
2901 N CENTRAL AVE |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85012-2700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114907821 | Dennis Carl Brydon | Anesthesiology | 2901 N Central Ave, Ste 500, Phoenix, AZ 85012-2738 | 2006-01-19 |
| 1447745690 | Sarah Rinehart | Pharmacist | 2901 N Central Ave, Phoenix, AZ 85012 | 2018-06-28 |
| 1790015972 | Virginia Boomershine | Pharmacist | 2901 N Central Ave, Phoenix, AZ 85012-2700 | 2010-01-11 |
| 1013130145 | Banner Health | Home Health | 2901 N Central Ave, Phoenix, AZ 85012-2700 | 2007-04-10 |
| 1578595377 | Paul Simmonds | Anesthesiology | 2901 N Central Ave, Suite 500, Phoenix, AZ 85012-2700 | 2006-07-06 |
| 1699702530 | Robert A Baratz | Anesthesiology | 2901 N Central Ave, Suite 500, Phoenix, AZ 85012-2700 | 2006-06-27 |
| 1710959796 | James Macpherson Tillinghast | Anesthesiology | 2901 N Central Ave, Ste 500, Phoenix, AZ 85012-2738 | 2006-02-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881205417 | Diligence Physical Therapy and Wellness, Pllc | Physical Therapist | 3101 N. Central Avenue, Suite 183 # 518, Phoenix, AZ 85012 | 2020-08-17 |
| 1962023135 | Kelee Jade Forst | Student in an Organized Health Care Education/Training Program | 4001 N Third Street, Suite 290, Phoenix, AZ 85012 | 2020-04-29 |
| 1659911428 | Thomas James Blake | Social Worker | Phoenix Va Health Care System, 650 E Indian School Road, Phoenix, AZ 85012 | 2020-01-09 |
| 1598259467 | Luis F Fong | Registered Nurse | 3620 N. 3rd Street, Phoenix, AZ 85012 | 2018-06-14 |
| 1881196335 | Phoenix Surgical Solutions Pllc | Surgery | 6120 W Bell Rd Suite 130, Glendale, AZ 85012 | 2018-03-01 |
| 1679082523 | Christopher Ferguson | Physician Assistant | 1313 E. Osborn Rd., Ste 150, Phoenix, AZ 85012 | 2017-09-22 |
| 1861911323 | Viet Quoc Truong | Physician Assistant | 650 E Indian School Rd # 1, Phoenix, AZ 85012 | 2017-09-15 |
| 1720506389 | Erin Lynne Cody | Nurse Practitioner | 3003 N. 3rd St, Phoenix, AZ 85012 | 2017-09-05 |
| 1346694627 | Sharareh Najafi | Psychologist | 3450 N. 3rd Street, Phoenix, AZ 85012 | 2016-04-22 |
| 1548635824 | Rebekah June Daroff | Specialist/Technologist | 352 N Camelback Rd, Phoenix, AZ 85012 | 2015-12-11 |
| Find all providers in zip 85012 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194339200 | Madison Le | Family Medicine | 3037 W Cat Balue Dr, Phoenix, AZ 85027-2342 | 2020-09-04 |
| 1720604069 | Good Health Medical, PC | Family Medicine | 2632 S 83rd Ave Ste 113, Phoenix, AZ 85043-7206 | 2020-06-23 |
| 1427670751 | Florence Wellness Pllc | Family Medicine | 101 E Washington St Fl 7, Phoenix, AZ 85004-2450 | 2020-05-08 |
| 1437782257 | Jillian Knapp | Family Medicine | 521 W Butler Dr, Phoenix, AZ 85021-4526 | 2020-02-20 |
| 1861033912 | Vanessa Lissette Lara | Family Medicine | 1459 E Flower St, Phoenix, AZ 85014-5666 | 2019-09-30 |
| 1366007411 | Marceline E Ndum | Family Medicine | 10631 S. 51st Street, Suite 1, Phoenix, AZ 85044-5225 | 2019-05-03 |
| 1306318340 | Leah Margaret Hillier | Family Medicine | 1300 N 12th St - Suite 500, Phoenix, AZ 85006 | 2018-12-31 |
| 1326510389 | Leanne J Muniz | Family Medicine | 19635 N Cave Creek Rd Apt 344, Phoenix, AZ 85024-1879 | 2018-12-31 |
| 1164905535 | Clark Medical, Pllc | Family Medicine | 2601 N 3rd St Ste 106, Phoenix, AZ 85004-1144 | 2018-09-12 |
| 1780180901 | Babymoon Inn Family Care LLC | Family Medicine | 202 E Morris Dr, Phoenix, AZ 85012-2323 | 2018-04-05 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.