WHITE TANK MEDICAL PLLC
NPI 1306549837
Family Medicine in Surprise, AZ
About White Tank Medical Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WHITE TANK MEDICAL PLLC (NPI 1306549837) is a healthcare organization registered as a family medicine in Surprise, Arizona and active in the NPI registry since March 2023. The organization holds a CLIA Waiver certificate valid through December 20, 2026 and lists Justin James Woodside, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
White Tank Medical Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to White Tank Medical PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (3)
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 03D2273967
White Tank Medical PLLC · Surprise, 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 White Tank Medical PLLC's NPI number?
The NPI number for White Tank Medical PLLC is 1306549837. It was assigned to this organization in the NPPES registry on March 23, 2023.
Where is White Tank Medical PLLC located?
White Tank Medical PLLC is located at 18761 N Reems Rd Ste 400, Surprise, AZ 85374. The listed phone number is (623) 583-9180.
What is White Tank Medical PLLC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is White Tank Medical PLLC enrolled in Medicare?
Yes. White Tank Medical PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through White Tank Medical PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to White Tank Medical PLLC, in Chiropractic 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, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does White Tank Medical PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 03D2273967) is associated with this NPI, valid through December 20, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for White Tank Medical PLLC was last updated on March 23, 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.
# White Tank Medical Pllc · NPI 1306549837
Family Medicine organization in Surprise, Arizona. Organization record, active in the CMS NPPES registry since March 23, 2023.
## Identity
- **NPI:** 1306549837 (Entity type: Organization)
- **Enumerated:** March 23, 2023
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Justin Woodside, OWNER
## Practice location
- **Address:** 18761 N REEMS RD STE 400, Surprise, AZ 85374-8646
- **Phone:** (623) 583-9180
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Chiropractic (2), Nurse Practitioner (1); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 23, 2023
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1306549837) · Data from the CMS NPPES public registry.