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BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC
NPI 1396014403
Clinic/Center - Multi-Specialty in San Tan Valley, AZ

Active since December 19, 2011CLIA 03D2211681 · Waiver
37100 N GANTZEL RD STE 214, SAN TAN VALLEY, AZ 85140(480) 412-9400 Get Directions Write a Review

NPPES record last updated: April 16, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 16, 2026, Sep 13, 2024, Dec 28, 2021 (3 updates tracked since 2021).

About Banner Physician Super Specialists Arizona Llc NPPES

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

BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC (NPI 1396014403) is a healthcare organization registered as a multi-specialty in San Tan Valley, Arizona and active in the NPI registry since December 2011. The organization holds a CLIA Waiver certificate valid through January 28, 2027, maintains 5 additional practice locations, and lists Shiva Birdi, Ceo, as its authorized official.

NPPES Registry Identity

NPI1396014403
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameBANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC
Location Address37100 N GANTZEL RD STE 214San Tan Valley, AZ 85140-7353
Mailing Address2901 N Central Ave Ste 160Phoenix, AZ 85012-2702
Phone(480) 412-9400
Organization SubpartYesParent: Banner Medical Group
Authorized OfficialShiva BirdiCeo · (602) 747-4000
Enumeration DateDecember 19, 2011
Last NPPES UpdateApril 16, 20263 updates tracked since enumeration
NPPES CertifiedApril 16, 2026
✔ NPI 1396014403 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
37100 N GANTZEL RD STE 214, San Tan Valley, AZ 85140
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Secondary Practice Locations 5

Location 11811 E McMurray BlvdCasa Grande, AZ 85122-5404 · Phone (520) 374-6530
Location 22050 W Southern AveApache Junction, AZ 85120-7305 · Phone (480) 733-3300
Location 337000 N Gantzel RdQueen Creek, AZ 85140-7303 · Phone (480) 397-4000
Location 41760 E Florence Blvd Ste 100Casa Grande, AZ 85122-4765 · Phone (520) 374-6505
Location 517900 N Porter RdMaricopa, AZ 85138-4228 · Phone (520) 233-2500

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 03D2211681

Banner Physician Super Specialists Arizona LLC · Mesa, AZ
Active · expires Jan 28, 2027
CLIA Number03D2211681
Laboratory TypePhysician Office
Certificate Effective DateJanuary 29, 2025
Certificate Expiration DateJanuary 28, 2027
Laboratory DirectorAyah Y. Elmaghrabi
Laboratory Phone(480) 412-9400
Laboratory LocationBanner Physician Super Specialists Arizona LLC1432 S Dobson Rd Ste 301, Mesa, AZ 85202
CLIA data matches this NPI record on: 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 Banner Physician Super Specialists Arizona LLC's NPI number?

The NPI number for Banner Physician Super Specialists Arizona LLC is 1396014403. It was assigned to this organization in the NPPES registry on December 19, 2011.

Where is Banner Physician Super Specialists Arizona LLC located?

Banner Physician Super Specialists Arizona LLC is located at 37100 N Gantzel Rd Ste 214, San Tan Valley, AZ 85140. The listed phone number is (480) 412-9400.

What is Banner Physician Super Specialists Arizona LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Does Banner Physician Super Specialists Arizona LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D2211681) is associated with this NPI, valid through January 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Banner Physician Super Specialists Arizona LLC accept?

Health plans from Ambetter from Arizona Complete Health list Banner Physician Super Specialists Arizona 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 Banner Physician Super Specialists Arizona LLC was last updated on April 16, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.