BLACK DIAMOND MEDICAL LLC
NPI 1639644909
Nurse Practitioner - Primary Care in Peoria, AZ
About Black Diamond Medical Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BLACK DIAMOND MEDICAL LLC (NPI 1639644909) is a healthcare organization registered as a primary care in Peoria, Arizona and active in the NPI registry since October 2018. The organization lists Tonia Lanette Graham, Co-owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
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)
Black Diamond Medical Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Black Diamond Medical LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Black Diamond Medical LLC's NPI number?
The NPI number for Black Diamond Medical LLC is 1639644909. It was assigned to this organization in the NPPES registry on October 12, 2018.
Where is Black Diamond Medical LLC located?
Black Diamond Medical LLC is located at 20449 N Lake Pleasant Rd Ste 101, Peoria, AZ 85382. The listed phone number is (623) 322-0099.
What is Black Diamond Medical LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.
Is Black Diamond Medical LLC enrolled in Medicare?
Yes. Black Diamond Medical LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Black Diamond Medical LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Black Diamond Medical LLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Black Diamond Medical LLC was last updated on March 6, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.
# Black Diamond Medical Llc · NPI 1639644909
Primary Care organization in Peoria, Arizona. Organization record, active in the CMS NPPES registry since October 12, 2018.
## Identity
- **NPI:** 1639644909 (Entity type: Organization)
- **Enumerated:** October 12, 2018
- **Primary specialty:** Nurse Practitioner - Primary Care · taxonomy 363LP2300X
- **Organization subpart:** No
- **Authorized official:** Tonia Graham, CO-OWNER
## Practice location
- **Address:** 20449 N LAKE PLEASANT RD STE 101, Peoria, AZ 85382-2707
- **Phone:** (623) 322-0099
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 6, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1639644909) · Data from the CMS NPPES public registry.