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
NPPES record last updated: October 15, 2007. Verified against the NPPES registry weekly; last sync: July 12, 2026.
- 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 19 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 Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1134172679, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 61 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1134172679, enumerated 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.
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 verify.
