NORTHERN ARIZONA HEALTHCARE PROVIDER GROUP, LLC (NPI# 1649539677) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649539677 |
| Entity Type | Organization |
| Organization Name | NORTHERN ARIZONA HEALTHCARE PROVIDER GROUP, LLC |
| Other Organization Name | PEDIATRIC/PICU |
| Practice Address |
1200 N Beaver St Flagstaff AZ 86001-3118 |
| Mailing Address |
1200 N Beaver St Attn: Managed Care Contracting Flagstaff AZ 86001-3118 |
| Practice Telephone | 9287732120 |
| Mailing Telephone | 9282136543 |
| Mailing Fax Number | 9282143613 |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2019-04-17 |
| Authorized Official Name | RONALD F HAASE (NAH CHIEF SYSTEMS OFFICER) |
| Authorized Official Telephone | 9287732059 |
| Is Organization Subpart | Y |
| Parent Organization Name | NORTHERN ARIZONA HEALTHCARE CORP. |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Pediatric/PICU | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417384371 | Northern Arizona Healthcare Provider Group, LLC | Optometrist | 1298 W Finnie Flat Rd # 101, Camp Verde, AZ 86322-5958 | 2013-10-08 |
| 1851659817 | Northern Arizona Healthcare Provider Group, LLC | Surgery | 199 South Candy Lane, Cottonwood, AZ 86326-4183 | 2012-04-27 |
| 1184982266 | Northern Arizona Healthcare Provider Group, LLC | Family Medicine | 450 South Willard Street, Cottonwood, AZ 86326 | 2012-04-26 |
| 1386099869 | Northern Arizona Healthcare Provider Group, LLC | Anesthesiology | 1200 N. Beaver Street, Attn: Payer Credentialing, Flagstaff, AZ 86001-3118 | 2016-05-03 |
| 1295121903 | Northern Arizona Healthcare Provider Group, LLC | Obstetrics & Gynecology | 269 South Candy Lane, Flagstaff, AZ 86326 | 2015-04-09 |
| 1174914915 | Northern Arizona Healthcare Provider Group, LLC | Internal Medicine | 77 W Forest Ave, Flagstaff, AZ 86001-1479 | 2015-02-16 |
| 1699182188 | Northern Arizona Healthcare Provider Group, LLC | Internal Medicine | 77 W Forest Ave, Flagstaff, AZ 86001-1479 | 2014-07-16 |
| 1265846968 | Northern Arizona Healthcare Provider Group, LLC | Internal Medicine | 294 W State Route 89a, Cottonwood, AZ 86326-3754 | 2014-06-20 |
| 1740694470 | Northern Arizona Healthcare Provider Group, LLC | Family Medicine | 107 E Oak Ave, Flagstaff, AZ 86001-1818 | 2014-06-20 |
| 1003230830 | Northern Arizona Healthcare Provider Group, LLC | Psychologist | 107 E Oak Ave, Flagstaff, AZ 86001-1818 | 2014-02-14 |
| Street Address |
1200 N BEAVER ST |
| City | FLAGSTAFF |
| State | AZ |
| Zip Code | 86001-3118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346241189 | Alvin B Elisco | Internal Medicine | 1200 N Beaver St, Fmc Hospitalists, Flagstaff, AZ 86001-3118 | 2005-08-02 |
| 1285240515 | Amika Noel | Nurse Anesthetist, Certified Registered | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2020-09-22 |
| 1669084190 | Margaret Grace Mcgough | Registered Nurse | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2020-08-17 |
| 1942818398 | Regan Rowson | Registered Nurse | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2020-07-21 |
| 1871118984 | Nancy Gloria Flores | Audiologist | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2020-06-15 |
| 1679100705 | Kristy Anderson | Occupational Therapist | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2020-03-26 |
| 1164058087 | Bryan J Ebeling | Nurse Practitioner | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2020-03-23 |
| 1447808407 | Bryce Aldworth Randall | Registered Nurse | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2019-09-03 |
| 1851952162 | Samuel Small | Nurse Practitioner | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2019-06-26 |
| 1235797283 | Rebecca R Boger | Dietitian, Registered | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2019-06-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427658756 | Marlenne Adair Escobar-mendoza | Specialist/Technologist | 1705 South San Francisco Street, Flagstaff, AZ 86001 | 2020-10-27 |
| 1962033712 | Laura-lee Prescott | Social Worker | Northern Az Va Healthcare System, Flagstaff Cboc, 1300 W. University Ave., Suite 300, Flagstaff, AZ 86001 | 2020-01-30 |
| 1194360784 | Trinity Medical Consultants Pllc | Internal Medicine | 1521 N Cliff Drive, Flagstaff, AZ 86001 | 2019-11-07 |
| 1154849610 | Altacare, LLC | Family Medicine | 2700 S Woodlands Village Blvd Ste 700, Flagstaff, AZ 86001 | 2017-09-05 |
| 1487174926 | Lindsey Marie Forstie | Nurse Practitioner | 7263 E Dreamview Trail, Flagstaff, AZ 86001 | 2017-06-26 |
| 1255860763 | Welbrook Senior Living Flagstaff LLC | Skilled Nursing Facility | 1521 N Pine Cliff Dr, Flagstaff, AZ 86001 | 2017-06-08 |
| 1912432675 | Ryan Tiscareno | Specialist/Technologist | 621 West Cherry Ave, Flagstaff, AZ 86001 | 2017-05-01 |
| 1629432380 | Behavioral Consultation Services, Inc. | Clinic/Center | 345 S. River Run Road, Suite 200, Flagstaff, AZ 86001 | 2016-04-08 |
| 1275920928 | Junli Gallagher | Speech-Language Pathologist | 1215 N. Beaver St, Flagstaff, AZ 86001 | 2015-04-21 |
| 1932592599 | Kristen Flugstad Psyd, LLC | Psychologist | 125 East Elm Avenue #203, Flagstaff, AZ 86001 | 2015-03-06 |
| Find all providers in zip 86001 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538505235 | Norina Danielle Witt | Pediatrics | 1501 S Yale St Ste 252, Flagstaff, AZ 86001-7336 | 2013-05-21 |
| 1831317817 | David Allen Spence | Pediatrics | 8610 Arroyo Trl, Flagstaff, AZ 86004-1294 | 2007-04-23 |
| 1366562944 | Mountain View Pediatrics | Pediatrics | 77 W Forest Ave Ste 304, Flagstaff, AZ 86001-1481 | 2007-03-29 |
| 1669911764 | North Country Healthcare, Inc. | Pediatrics | 1501 S Yale St, Ste 252, Flagstaff, AZ 86001-7304 | 2017-02-22 |
| 1639564453 | Mary Elizabeth Smith Iles | Pediatrics | 77 W Forest Ave, Flagstaff, AZ 86001 | 2015-03-30 |
| 1669815825 | Lauren Diane Hayward | Pediatrics | 77 W Forest Ave, Suite 304, Flagstaff, AZ 86001-1479 | 2013-04-08 |
| 1699926048 | April C Alvarez-corona | Pediatrics | 2920 N 4th St, Flagstaff, AZ 86004-1816 | 2008-10-03 |
| 1154595411 | Mark F Carroll | Pediatrics | 1215 N Beaver St, Suite 201, Flagstaff, AZ 86001-3126 | 2008-04-17 |
| 1174716526 | Julia Beth Eskuchen | Pediatrics | 2920 N 4th St, Flagstaff, AZ 86004-1816 | 2007-08-20 |
| 1043381809 | James Wallace Mathewson | Pediatrics | 1330 N Rim Dr, Suite A, Flagstaff, AZ 86001-3134 | 2006-11-13 |
| Find all providers in FLAGSTAFF | ||||
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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.