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PEBBLE CREEK MEDICAL GROUP PLLC
NPI 1790213064
Internal Medicine in Goodyear, AZ

Active since May 31, 2017
700 N ESTRELLA PKWY # 130, GOODYEAR, AZ 85338(623) 322-2144(623) 322-1165 Get Directions Write a Review

NPPES record last updated: May 31, 2017. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Pebble Creek Medical Group Pllc NPPES

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

PEBBLE CREEK MEDICAL GROUP PLLC (NPI 1790213064) is a healthcare organization registered as an internal medicine in Goodyear, Arizona and active in the NPI registry since May 2017. The organization lists Sanjay Bommakanti, Md/owner, as its authorized official.

NPPES Registry Identity

NPI1790213064
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NamePEBBLE CREEK MEDICAL GROUP PLLC
Location Address700 N ESTRELLA PKWY # 130Goodyear, AZ 85338-9271
Mailing Address18210 N Organ Pipe DrSun City, AZ 85373-1757 · (602) 410-6951 · Fax (480) 304-3234
Phone(623) 322-2144
Fax(623) 322-1165
Organization SubpartNo
Authorized OfficialSanjay BommakantiMd/owner · (623) 337-6897
Enumeration DateMay 31, 2017
✔ NPI 1790213064 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in AZ · 37252
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
700 N ESTRELLA PKWY # 130, Goodyear, AZ 85338
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Other Identifiers 1

Medicaid281108AZ

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)

Pebble Creek Medical Group Pllc 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 Pebble Creek Medical Group PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Fnu Pranav, MD
Internal Medicine
NPI 1952327116
700 N ESTRELLA PKWY # 130
Goodyear, AZ 85338
(623) 322-2144
✔ 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.

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 Pebble Creek Medical Group PLLC's NPI number?

The NPI number for Pebble Creek Medical Group PLLC is 1790213064. It was assigned to this organization in the NPPES registry on May 31, 2017.

Where is Pebble Creek Medical Group PLLC located?

Pebble Creek Medical Group PLLC is located at 700 N Estrella Pkwy # 130, Goodyear, AZ 85338. The listed phone number is (623) 322-2144.

What is Pebble Creek Medical Group PLLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Pebble Creek Medical Group PLLC enrolled in Medicare?

Yes. Pebble Creek Medical Group PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Pebble Creek Medical Group PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Pebble Creek Medical Group 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Pebble Creek Medical Group PLLC was last updated on May 31, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.