SOUTHWEST I.D. & MEDICAL CLINIC, LC
NPI 1275563975
Internal Medicine - Infectious Disease in Prescott Valley, AZ
About Southwest I.d. & Medical Clinic, Lc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTHWEST I.D. & MEDICAL CLINIC, LC (NPI 1275563975) is a healthcare organization registered as an infectious disease in Prescott Valley, Arizona and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through April 3, 2027 and lists Alpana Jetly, Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Southwest I.d. & Medical Clinic, Lc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Southwest I.D. & Medical Clinic, Lc, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 03D2056808
Southwest Id & Med Clinic · Prescott Valley, AZFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Southwest I.D. & Medical Clinic, Lc's NPI number?
The NPI number for Southwest I.D. & Medical Clinic, Lc is 1275563975. It was assigned to this organization in the NPPES registry on July 5, 2006.
Where is Southwest I.D. & Medical Clinic, Lc located?
Southwest I.D. & Medical Clinic, Lc is located at 3235 N Windsong Dr, Prescott Valley, AZ 86314. The listed phone number is (928) 772-3340.
What is Southwest I.D. & Medical Clinic, Lc's specialty?
The primary specialty registered for this NPI is Internal Medicine, specializing in Infectious Disease, with taxonomy code 207RI0200X.
Is Southwest I.D. & Medical Clinic, Lc enrolled in Medicare?
Yes. Southwest I.D. & Medical Clinic, Lc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Southwest I.D. & Medical Clinic, Lc?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Southwest I.D. & Medical Clinic, Lc, in Internal Medicine and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Southwest I.D. & Medical Clinic, Lc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 03D2056808) is associated with this NPI, valid through April 3, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Southwest I.D. & Medical Clinic, Lc accept?
Health plans from Ambetter Health and Ambetter from Arizona Complete Health list Southwest I.D. & Medical Clinic, Lc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Southwest I.D. & Medical Clinic, Lc was last updated on September 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Southwest I.d. & Medical Clinic, Lc · NPI 1275563975
Infectious Disease organization in Prescott Valley, Arizona. Organization record, active in the CMS NPPES registry since July 5, 2006.
## Identity
- **NPI:** 1275563975 (Entity type: Organization)
- **Enumerated:** July 5, 2006
- **Primary specialty:** Internal Medicine - Infectious Disease · taxonomy 207RI0200X
- **Organization subpart:** No
- **Authorized official:** Alpana Jetly, MANAGER
## Practice location
- **Address:** 3235 N WINDSONG DR, Prescott Valley, AZ 86314-1222
- **Phone:** (928) 772-3340 · **Fax:** (928) 759-9611
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Internal Medicine (1), Nurse Practitioner (1); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 7, 2023
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1275563975) · Data from the CMS NPPES public registry.