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MANZANITA MEDICAL PLLC
NPI 1306376611
Family Medicine in Phoenix, AZ

Active since June 19, 2017CLIA 03D2132669 · Waiver
4545 E SHEA BLVD STE 130, PHOENIX, AZ 85028(480) 292-9532(480) 664-3482 Get Directions Write a Review

NPPES record last updated: July 23, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 23, 2024, Oct 25, 2022, Jul 26, 2017 and 1 more (4 updates tracked since 2017).

About Manzanita Medical Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MANZANITA MEDICAL PLLC (NPI 1306376611) is a healthcare organization registered as a family medicine in Phoenix, Arizona and active in the NPI registry since June 2017. The organization holds a CLIA Waiver certificate valid through June 25, 2027 and lists Judith Hallas, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1306376611
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameMANZANITA MEDICAL PLLC
Location Address4545 E SHEA BLVD STE 130Phoenix, AZ 85028-3061
Mailing Address4545 E Shea Blvd Ste 130Phoenix, AZ 85028-3061 · (480) 292-9532 · Fax (480) 664-3482
Phone(480) 292-9532
Fax(480) 664-3482
Organization SubpartNo
Authorized OfficialJudith HallasOffice Manager · (480) 292-9532
Enumeration DateJune 19, 2017
Last NPPES UpdateJuly 23, 20244 updates tracked since enumeration
NPPES CertifiedMay 8, 2023
✔ NPI 1306376611 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
4545 E SHEA BLVD STE 130, Phoenix, AZ 85028
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Manzanita Medical Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Manzanita Medical PLLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Mayy Deadrick, M.D.
Family Practice
NPI 1194741074
4545 E SHEA BLVD STE 130
Phoenix, AZ 85028
(480) 292-9532
✔ PECOS✔ Accepts MedicareSame address
Shayna Mansfield, D.O.
Family Practice
NPI 1780687087
4545 E SHEA BLVD STE 130
Phoenix, AZ 85028
(480) 292-9532
✔ PECOS✔ Accepts MedicareSame address

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 03D2132669

Manzanita Medical PLLC · Phoenix, AZ
Active · expires Jun 25, 2027
CLIA Number03D2132669
Laboratory TypePhysician Office
Certificate Effective DateJune 26, 2025
Certificate Expiration DateJune 25, 2027
Laboratory DirectorMayy S. Deadrick
Laboratory Phone(480) 292-9532
Laboratory LocationManzanita Medical PLLC4545 E Shea Blvd Ste 130, Phoenix, AZ 85028
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently 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 Manzanita Medical PLLC's NPI number?

The NPI number for Manzanita Medical PLLC is 1306376611. It was assigned to this organization in the NPPES registry on June 19, 2017.

Where is Manzanita Medical PLLC located?

Manzanita Medical PLLC is located at 4545 E Shea Blvd Ste 130, Phoenix, AZ 85028. The listed phone number is (480) 292-9532.

What is Manzanita Medical PLLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Manzanita Medical PLLC enrolled in Medicare?

Yes. Manzanita Medical PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Manzanita Medical PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Family Practice, reassign their Medicare billing to Manzanita Medical PLLC. 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 Manzanita Medical PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D2132669) is associated with this NPI, valid through June 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Manzanita Medical PLLC was last updated on July 23, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.