BANNER GOOD SAMARITAN BARIATRIC PROGRAM
NPI 1134172679
Clinic/Center in Phoenix, AZ
NPI Status: Active since May 18, 2006
Contact Information
1300 N 12TH ST
PHOENIX, AZ
ZIP 85006
Phone: (602) 239-5000
Fax: (602) 239-3339
- Organization
- Clinic/Center
- CLIA Number: 03D2303550
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 04-25-2026
About BANNER GOOD SAMARITAN BARIATRIC PROGRAM
This page provides the complete NPI Profile along with additional information for Banner Good Samaritan Bariatric Program, a provider established in Phoenix, Arizona operating as a Clinic/center. The healthcare provider is registered in the NPI registry with number 1134172679 assigned on May 2006. The practitioner's primary taxonomy code is 261Q00000X. The provider is registered as an organization and their NPI record was last updated 18 years ago. The authorized official of this NPI record is Dennis Dahlen (Sr Vice President - Finance)
- NPI
- 1134172679
- Provider Name
- BANNER GOOD SAMARITAN BARIATRIC PROGRAM
- Entity Type
- Organization
- Location Address
- 1300 N 12TH ST PHOENIX, AZ 85006
- Location Phone
- (602) 239-5000
- Location Fax
- (602) 239-3339
- Mailing Address
- 1441 N 12TH ST PHOENIX, AZ 85006
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 05-18-2006
- Last Update Date
- 10-15-2007
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center
- Taxonomy Code
- 261Q00000X
- Type
- Ambulatory Health Care Facilities
- Taxonomy Description
- A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| Z77043 | MEDICARE PIN (08) | AZ | |
| 810871 | MEDICAID (05) | AZ |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 03D2303550
- Facility Type
- Physician Office
- Certificate Effective Date
- April 26, 2024
- Certificate Expiration Date
- April 25, 2026
- Laboratory Director
- JENNA BUCHANAN
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Banner Good Samaritan Bariatric Program in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 1 | 3 | 4 | 1 | 7 | 2 | 6 | 7 | 9 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 1 | 6 | 4 | 2 | 7 | 4 | 6 | 14 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 1 + 6 + 4 + 2 + 7 + 4 + 6 + 1 + 4 + 24 = 61 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 61 = 9 | 9 | ||||||||
The NPI number 1134172679 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1831192590 | WILLIAM WALTER HOLLAND M.D. Individual | Family Medicine | 1300 N 12TH ST SUITE 605 PHOENIX, AZ 85006 (602) 239-4567 |
| 1518960996 | ANDRZEJ DMOWSKI MD Individual | Emergency Medicine | 1300 N 12TH ST SUITE 301 PHOENIX, AZ 85006 (602) 239-6968 |
| 1740287002 | MS. TAMARA GALLOWAY PT Individual | Physical Therapist | 1300 N 12TH ST STE 506 PHOENIX, AZ 85006 (602) 253-6623 |
| 1730161043 | PAUL HAY PA Individual | Physician Assistant | 1300 N 12TH ST PHOENIX, AZ 85006 (602) 839-6968 |
| 1447222328 | MRS. JACQUELINE LEA AGENBROAD NP Individual | Nurse Practitioner | 1300 N 12TH ST SUITE 407 PHOENIX, AZ 85006 (602) 239-6762 |
| 1154395531 | LORNA F HONAN MD Individual | Internal Medicine | 1300 N 12TH ST STE 518 PHOENIX, AZ 85006 (602) 257-9488 |
| 1891760062 | MINIMALLY INVASIVE SURGICAL CONSULTANTS PLC Organization | Surgery | 1300 N 12TH ST #616 PHOENIX, AZ 85006 (602) 257-0300 |
| 1518935592 | PAUL E STANDER M.D Individual | Internal Medicine | 1300 N 12TH ST SUITE 508 PHOENIX, AZ 85006 (602) 239-3927 |
| 1043288327 | BARBARA J RUNQUIST NP Individual | Nurse Practitioner | 1300 N 12TH ST SUITE 404 PHOENIX, AZ 85006 (602) 839-0265 |
| 1255300224 | NANCEE E VANDERPLUYM M.N.T. Individual | Dietitian, Registered | 1300 N 12TH ST SUITE 610 PHOENIX, AZ 85006 (602) 239-5000 |
| 1356319495 | MARY ELLEN DIRLAM M.D. Individual | Internal Medicine | 1300 N 12TH ST SUITE 508 PHOENIX, AZ 85006 (602) 495-4577 |
| 1922077742 | JEFFREY D WOLFREY M.D. Individual | Family Medicine | 1300 N 12TH ST PHOENIX, AZ 85006 (602) 239-4567 |
| 1669441408 | ROBYN L PROSSER R.D., C.D.E. Individual | Dietitian, Registered | 1300 N 12TH ST SUITE 610 PHOENIX, AZ 85006 (602) 239-5000 |
| 1982673711 | CHERYL J PAGEL M.D. Individual | Family Medicine | 1300 N 12TH ST PHOENIX, AZ 85006 (602) 239-4567 |
| 1164491510 | CHERYL R. BUYAMA M.D. Individual | Internal Medicine | 1300 N 12TH ST SUITE 508 PHOENIX, AZ 85006 (602) 839-3927 |
| 1659330769 | HARVEY HSU M.D. Individual | Internal Medicine | 1300 N 12TH ST SUITE 508 PHOENIX, AZ 85006 (602) 239-4161 |
| 1972562411 | MRS. PATTI LYNNE KILLINGSWORTH M.SC. Individual | Rehabilitation Practitioner | 1300 N 12TH ST PHOENIX, AZ 85006 (602) 239-5000 |
| 1083674154 | STEVEN R BROWN M.D. Individual | Family Medicine | 1300 N 12TH ST SUITE 605 PHOENIX, AZ 85006 (602) 239-4567 |
| 1346200219 | KRISTINA M COOPER PH.D. Individual | Psychologist (Clinical) | 1300 N 12TH ST SUITE 610 PHOENIX, AZ 85006 (602) 239-5000 |
| 1871553693 | MARK R STEPHAN M.D. Individual | Family Medicine | 1300 N 12TH ST SUITE 605 PHOENIX, AZ 85006 (602) 239-4567 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1134172679, enumerated in the NPI registry as an "organization" on May 18, 2006
The provider is located at 1300 N 12th St Phoenix, Az 85006 and the phone number is (602) 239-5000
This medical organization specializes in Clinic/Center with taxonomy code 261Q00000X
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 03D2303550 for a "physician office" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing..
This NPI record was last updated on May 18, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.