CCENT & FPS (NPI# 1467629469) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467629469 |
| Entity Type | Organization |
| Organization Name | CCENT & FPS |
| Practice Address |
300 W White Mountain Blvd Suite D Lakeside AR 85929-6533 |
| Mailing Address |
1340 N Rim Drive Flagstaff AZ 86001-1311 |
| Practice Telephone | 9287741873 |
| Mailing Telephone | 9287741873 |
| Mailing Fax Number | 9287745525 |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2008-05-09 |
| Authorized Official Name | DR. TAMARAH A FRATIANNI (PHYSICIAN) |
| Authorized Official Telephone | 9287741873 |
| Authorized Official Credential | D.O |
| Is Organization Subpart | Y |
| Parent Organization Name | CCENT & FPS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207YX0905X |
Otolaryngology Specialization: Otolaryngology/Facial Plastic Surgery |
3000 | AZ | Allopathic & Osteopathic Physicians |
| Y | 207K00000X | Allergy & Immunology | 3000 | AZ | Allopathic & Osteopathic Physicians |
| Street Address |
300 W WHITE MOUNTAIN BLVD SUITE D |
| City | LAKESIDE |
| State | AR |
| Zip Code | 85929-6533 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265402622 | Gaylon Crawford | Family Medicine | 300 W White Mountain Blvd, Ste D, Lakeside, AZ 85929-7014 | 2006-01-26 |
| 1124479910 | Honor Family Healthcare, LLC | Family Medicine | 300 W White Mountain Blvd, Suite D, Lakeside, AZ 85929-7014 | 2016-06-23 |
| 1295049914 | Michael J Sassmann | Physician Assistant | 300 W White Mountain Blvd, Suitea, Lakeside, AZ 85929-7014 | 2010-08-05 |
| 1851425359 | Gaylon E Crawford Do Inc | Family Medicine | 300 W White Mountain Blvd, Suite A, Lakeside, AZ 85929 | 2007-03-15 |
| 1407969637 | High Pines Urology PC | Urology | 300 W White Mountain Blvd, Suite C, Lakeside, AZ 85929 | 2006-08-15 |
| 1669445706 | Leon A Driss | Internal Medicine | 300 W White Mountain Blvd, Suite A, Lakeside, AZ 85929-7014 | 2006-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689272700 | Pediatric Multicare West, LLC | Pediatrics | 316 W. White Mountain Blvd., Suite A, Lakeside, AZ 85929 | 2020-10-12 |
| 1841836285 | Changepoint Integrated Health | Community/Behavioral Health | 1920 West Commerce Dr, Lakeside, AZ 85929 | 2019-11-20 |
| 1184111692 | Statclinix Plc | Clinic/Center | 3457 W White Mountain Blvd, Lakeside, AZ 85929 | 2018-04-19 |
| 1154827863 | Advanced Health and Wellness Az | Clinic/Center | 4830 Highway 260 Ste 102, Lakeside, AZ 85929 | 2018-04-02 |
| 1740648260 | Ries Chiropractic and Rehabilitation Center LLC | Point of Service | 5658 Hwy 260 Ste 1, Lakeside, AZ 85929 | 2016-01-29 |
| 1912395807 | Samuel Jesus Rosero Garcia | Family Medicine | 300 W. White Mountain Blvd, Suite D, Lakeside, AZ 85929 | 2014-12-31 |
| 1104178326 | Ronald T. Watanabe | Chiropractor | 20 West White Mountain Road, Safeway Pharmacy, Lakeside, AZ 85929 | 2012-10-11 |
| 1962705442 | San Tan Behavioral Health Services | Non-emergency Medical Transport (VAN) | 1277 Hummingbird Circle, Lakeside, AZ 85929 | 2010-12-06 |
| 1609181718 | Freter Family Practice Pllc | Family Medicine | 5448 S. White Mountain Blvd, 270, Lakeside, AZ 85929 | 2010-08-12 |
| 1760701221 | Sierra Blanca Rehabilitation LLC | Skilled Nursing Facility | 3401 N Lockwood Dr, Lakeside, AZ 85929 | 2010-05-24 |
| Find all providers in zip 85929 | ||||
| Taxonomy Code | 207K00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Allergy & Immunology |
| An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system. |
| Notes: Source: American Board of Medical Specialties, 2007, www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Allergy and Immunology, 2007. http://www.abai.org/ No subspecialty certificates in allergy and immunology are offered by the American Board of Allergy and Immunology (ABAI). The ABAI, however, does offer formal special pathways for physicians seeking dual certification in allergy/immunology and pediatric pulmonology; allergy/immunology and pediatric rheumatology; and allergy/immunology and adult rheumatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275968786 | Bill F Hefley Sr. | Allergy & Immunology | 361 Valley Club Circle, Little Rock, AR 72212 | 2013-09-04 |
| 1972850907 | Kelsy J Caplinger | Allergy & Immunology | 12400 Hunters Glen Blvd, #37, Little Rock, AR 72211-2232 | 2012-08-09 |
| 1710218995 | Medical Associates of Northwest Arkansas | Allergy & Immunology | 3383 N Mana Ct, Suite 201, Fayetteville, AR 72703-4960 | 2010-01-27 |
| 1366464711 | James T Howell | Allergy & Immunology | 3416 Old Greenwood Rd, Fort Smith, AR 72903-5462 | 2006-07-24 |
| 1881623965 | Curtis Lars Hedberg | Allergy & Immunology | 700 S 52nd St, Rogers, AR 72758 | 2006-07-01 |
| 1467497461 | Brian D Jackson | Allergy & Immunology | 151 Harmony Park Circle, Hot Springs, AR 71913 | 2006-06-17 |
| 1609837459 | Arkansas Allergy & Asthma Clinic, P.a. | Allergy & Immunology | 400 Salem Rd, Suite 4, Conway, AR 72034-6162 | 2006-03-31 |
| 1568423309 | Arkansas Allergy & Asthma Clinic, P.a. | Allergy & Immunology | 2504 Mccain Blvd, Suite 118, North Little Rock, AR 72116-7608 | 2006-03-31 |
| 1447226477 | Jerry Lynn Potts | Allergy & Immunology | 1408 W 43rd Ave, Pine Bluff, AR 71603-7010 | 2006-02-28 |
| 1932188067 | Aubrey Ziegler | Allergy & Immunology | 520 Towson Ave Ste A, Fort Smith, AR 72901-4624 | 2006-01-17 |
| Find all providers with the same taxonomy | ||||
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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.