BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC
NPI 1790337665
Nutritionist - Nutrition, Education in Mesa, AZ
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 1790337665) is a healthcare organization registered as a nutrition, education in Mesa, Arizona and active in the NPI registry since July 2019. The organization holds a CLIA Waiver certificate valid through November 27, 2027 and lists Dennis Laraway, Cfo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
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)
Banner Physician Super Specialists Arizona Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
186Medicare enrollment records show 186 clinicians reassign Medicare billing to Banner Physician Super Specialists Arizona LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 60 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 31
Nearest to this location (20)
See all 186Source: 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 03D0993904
Banner Physician Super Specialists Arizona LLC · Mesa, 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 Banner Physician Super Specialists Arizona LLC's NPI number?
The NPI number for Banner Physician Super Specialists Arizona LLC is 1790337665. It was assigned to this organization in the NPPES registry on July 11, 2019.
Where is Banner Physician Super Specialists Arizona LLC located?
Banner Physician Super Specialists Arizona LLC is located at 1450 S Dobson Rd Ste B221, Mesa, AZ 85202. The listed phone number is (480) 827-5370.
What is Banner Physician Super Specialists Arizona LLC's specialty?
The primary specialty registered for this NPI is Nutritionist, specializing in Nutrition, Education, with taxonomy code 133NN1002X.
Is Banner Physician Super Specialists Arizona LLC enrolled in Medicare?
Yes. Banner Physician Super Specialists Arizona LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Banner Physician Super Specialists Arizona LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 186 clinicians in 31 Medicare specialties reassign their Medicare billing to Banner Physician Super Specialists Arizona 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. The largest specialties are Pediatric Medicine (84), Nurse Practitioner (21) and General Surgery (6). Of these, 2 practice at this address and 60 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Banner Physician Super Specialists Arizona LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 03D0993904) is associated with this NPI, valid through November 27, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Banner Physician Super Specialists Arizona LLC was last updated on December 28, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Banner Physician Super Specialists Arizona Llc · NPI 1790337665
Nutrition, Education organization in Mesa, Arizona. Organization record, active in the CMS NPPES registry since July 11, 2019.
## Identity
- **NPI:** 1790337665 (Entity type: Organization)
- **Enumerated:** July 11, 2019
- **Primary specialty:** Nutritionist - Nutrition, Education · taxonomy 133NN1002X
- **Organization subpart:** Yes (part of Banner Health)
- **Authorized official:** Dennis Laraway, CFO
## Practice location
- **Address:** 1450 S DOBSON RD STE B221, Mesa, AZ 85202-4745
- **Phone:** (480) 827-5370
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 186 clinicians in 31 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Pediatric Medicine (84), Nurse Practitioner (21), General Surgery (6); 2 practice at this address and 60 within 10 miles; [full list](https://npiprofile.com/npi/1790337665/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 28, 2021
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1790337665) · Data from the CMS NPPES public registry.