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SOUTHWELLNESS MEDICAL LLC
NPI 1366099533
Family Medicine in Paradise Valley, AZ

Active since August 22, 2019CLIA 03D2214551 · Waiver
10599 N TATUM BLVD STE F151, PARADISE VALLEY, AZ 85253(480) 991-9271(844) 284-7758 Get Directions Write a Review

NPPES record last updated: October 15, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 15, 2020, Aug 22, 2019 (2 updates tracked since 2019).

About Southwellness Medical Llc NPPES

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

SOUTHWELLNESS MEDICAL LLC (NPI 1366099533) is a healthcare organization registered as a family medicine in Paradise Valley, Arizona and active in the NPI registry since August 2019. The organization holds a CLIA Waiver certificate valid through February 22, 2027 and lists Tyler John Southwell, Ceo, as its authorized official.

NPPES Registry Identity

NPI1366099533
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSOUTHWELLNESS MEDICAL LLC
Location Address10599 N TATUM BLVD STE F151Paradise Valley, AZ 85253-1053
Mailing Address10599 N Tatum Blvd Ste F151Paradise Valley, AZ 85253-1053 · (480) 991-9271 · Fax (844) 284-7758
Phone(480) 991-9271
Fax(844) 284-7758
Organization SubpartNo
Authorized OfficialTyler John SouthwellCeo · (480) 991-9271
Enumeration DateAugust 22, 2019
Last NPPES UpdateOctober 15, 20202 updates tracked since enumeration
NPPES CertifiedOctober 15, 2020
✔ NPI 1366099533 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.
10599 N TATUM BLVD STE F151, Paradise Valley, AZ 85253
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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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health.Insurance ›

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 03D2214551

Southwellness Medical LLC · Paradise Valley, AZ
Active · expires Feb 22, 2027
CLIA Number03D2214551
Laboratory TypePhysician Office
Certificate Effective DateFebruary 23, 2025
Certificate Expiration DateFebruary 22, 2027
Laboratory DirectorTyler Southwell
Laboratory Phone(480) 991-9271
Laboratory LocationSouthwellness Medical LLC10599 N Tatum Blvd Suite F151, Paradise Valley, AZ 85253
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TYLER JOHN SOUTHWELL M.D.
Family Medicine
10599 N TATUM BLVD STE F151
PARADISE VALLEY, AZ 85253
Maricopa County (480) 991-9271
ROSA SHANTAL KINGSLEY FNP-C
Nurse Practitioner (Family)
10599 N TATUM BLVD STE F151
PARADISE VALLEY, AZ 85253
Maricopa County (480) 991-9271
LAUREN PREBLE RN
Registered Nurse
10599 N TATUM BLVD STE F151
PARADISE VALLEY, AZ 85253
Maricopa County (480) 991-9271
MS. DINA MARIE BALZANO DNP
Nurse Practitioner (Family)
10599 N TATUM BLVD STE F151
PARADISE VALLEY, AZ 85253
Maricopa County (480) 991-9271

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 Southwellness Medical LLC's NPI number?

The NPI number for Southwellness Medical LLC is 1366099533. It was assigned to this organization in the NPPES registry on August 22, 2019.

Where is Southwellness Medical LLC located?

Southwellness Medical LLC is located at 10599 N Tatum Blvd Ste F151, Paradise Valley, AZ 85253. The listed phone number is (480) 991-9271.

What is Southwellness Medical LLC's specialty?

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

Does Southwellness Medical LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D2214551) is associated with this NPI, valid through February 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Southwellness Medical LLC accept?

Health plans from Ambetter from Arizona Complete Health list Southwellness Medical LLC 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 Southwellness Medical LLC was last updated on October 15, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.