MIRAGE MEDICAL LLC (NPI# 1609206549) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609206549 |
| Entity Type | Organization |
| Organization Name | MIRAGE MEDICAL LLC |
| Practice Address |
10046 N Metro Pkwy W Suite 115 Phoenix AZ 85051-1437 |
| Mailing Address |
1001 E Warner Rd Suite 107 Tempe AZ 85284-3224 |
| Practice Telephone | 6026745515 |
| Practice Fax Number | 6026743029 |
| Mailing Telephone | 4802643744 |
| Mailing Fax Number | 4802642075 |
| Enumeration Date | 2013-11-13 |
| Last Update Date | 2013-11-13 |
| Authorized Official Name | DR. JEREMY R BUCKNER (OWNER) |
| Authorized Official Telephone | 6024212730 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP4986 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| N | 364SF0001X |
Clinical Nurse Specialist Specialization: Family Health |
AP2828 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
5988 | AZ | Allopathic & Osteopathic Physicians |
| Street Address |
10046 N METRO PKWY W SUITE 115 |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85051-1437 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174719397 | Patricia Kate Paradis | Clinical Nurse Specialist | 10046 N Metro Pkwy W, Suite 115, Phoenix, AZ 85051-1437 | 2007-09-20 |
| 1841731932 | Metro Otc, LLC | Clinic/Center | 10046 N Metro Pkwy W, Suite 115, Phoenix, AZ 85051 | 2017-03-09 |
| 1992123046 | Olga Matatova | Physician Assistant | 10046 N Metro Pkwy W, 115, Phoenix, AZ 85051-1437 | 2014-04-04 |
| 1558786509 | Joan Denny | Nurse Practitioner | 10046 N Metro Pkwy W, Phoenix, AZ 85051-1437 | 2014-02-27 |
| 1003237801 | Buck Healthcare LLC | Nurse Practitioner | 10046 N Metro Pkwy W, Suite 115, Phoenix, AZ 85051-1437 | 2013-12-20 |
| 1194146993 | Gigi Healthcare LLC | Nurse Practitioner | 10046 N Metro Pkwy W, Suite 115, Phoenix, AZ 85051-1437 | 2013-12-20 |
| 1295018919 | Kd Chiropractic LLC | Chiropractor | 10046 N Metro Pkwy W, Ste 115, Phoenix, AZ 85051-1437 | 2011-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184250383 | Jhajaira Elizabeth Cadenas | Optometrist | 3937 W Northview Ave, Phoenix, AZ 85051 | 2020-03-19 |
| 1083270854 | Vision With Wings | Voluntary or Charitable | 9617 N. Metro Pkwy West, Ste. 1214, Phoeniz, AZ 85051 | 2019-05-16 |
| 1417510405 | Applied Behavioral Interventions Pllc | Dietitian, Registered | 10000 N. 31st Avenue Ste. A107, Phoenix, AZ 85051 | 2019-04-16 |
| 1558832683 | Liberty Home LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 9649 N 36th Ave, Phoenix, AZ 85051 | 2018-12-16 |
| 1518459080 | Addie Robin Diroberts | Counselor | 10240 W. 31st Ave, Phoenix, AZ 85051 | 2018-05-31 |
| 1093239816 | Jason Allan Parker | Licensed Practical Nurse | 3310 West Cheryl Drive, Phoenix, AZ 85051 | 2017-08-02 |
| 1588019145 | Vanessa Eloise Hernandez | Counselor | 10000 N. 31st Ave., Applied Behavioral Interventions, Pllc, Phoenix, AZ 85051 | 2016-05-02 |
| 1912230178 | Mozelle Barr Martin | Counselor | 3734 W. Vista Ave., Phoenix, AZ 85051 | 2009-09-04 |
| 1316184542 | Tom Sowash Od & Associates PC | Optometrist | 9617 North Parkway West, #1160, Phoenix, AZ 85051 | 2009-01-09 |
| 1609026913 | Luma Z Sayegh | Dentist | 7012 N 35th Ave, Suite 1, Phoenix, AZ 85051 | 2008-09-23 |
| Find all providers in zip 85051 | ||||
| Taxonomy Code | 2081P2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pain Medicine |
| A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154967750 | Pain & Wellness of Arizona, LLC | Physical Medicine & Rehabilitation | 3120 E Union Hills Dr Ste 201, Phoenix, AZ 85050-3454 | 2019-11-19 |
| 1831730050 | Restorative Care of Arizona, P.C. | Physical Medicine & Rehabilitation | 2150 E Highland Ave Ste 107, Phoenix, AZ 85016-4720 | 2019-09-30 |
| 1306959218 | Center for Physical Medicine & Rehabilitation P C | Physical Medicine & Rehabilitation | 1331 N 7th St Ste 360, Phoenix, AZ 85006-2772 | 2006-08-16 |
| 1942238357 | Joshua Adam Levy | Physical Medicine & Rehabilitation | 3417 N 32nd St, Phoenix, AZ 85018-5606 | 2006-06-28 |
| 1114536992 | Elviam LLC | Physical Medicine & Rehabilitation | 22601 N 19th Ave Ste 100, Phoenix, AZ 85027-1324 | 2020-07-28 |
| 1831711019 | Premier Pain Specialists LLC | Physical Medicine & Rehabilitation | 4045 E Bell Rd Ste 147, Phoenix, AZ 85032-2239 | 2020-05-11 |
| 1700408960 | Pain Specialists of Arizona LLC | Physical Medicine & Rehabilitation | 4727 E Bell Rd, Phoenix, AZ 85032-2308 | 2020-05-11 |
| 1134753908 | Robert Glenn | Physical Medicine & Rehabilitation | 2836 E Indian School Rd Ste A8, Phoenix, AZ 85016-6864 | 2020-03-02 |
| 1699135483 | Modern Healthcare, Inc | Physical Medicine & Rehabilitation | 3201 W Peoria Ave Ste A105, Phoenix, AZ 85029-4609 | 2016-03-07 |
| 1679932206 | Karen Allyse Rosen-wasserman | Physical Medicine & Rehabilitation | 18444 N 25th Ave Ste 210, Phoenix, AZ 85023-1264 | 2016-02-10 |
| 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.