MOUNTAIN VISTA EMERGENCY PHYSICIANS, LLC – Emergency Medicine Physician, NPI 1164642963
Emergency Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MOUNTAIN VISTA EMERGENCY PHYSICIANS, LLC
861 SW 78TH AVE
# 100 B
PLANTATION, FL 333243273
Phone: (954) 693-0000
Fax: (954) 693-0005
Type: Mailing
1301 SOUTH CRISMON RD
EMERGENCY DEPARTMENT
MESA, AZ 85209
Phone: (480) 354-7585
Type: Location
4545 N Hunt Hwy
Florence, AZ 851326937
Phone: (480) 358-6100
Type: Location
1301 S Crismon Rd
Mesa, AZ 852093767
Phone: (480) 358-6100
Type: Location
200 CORPORATE BLVD
LAFAYETTE, LA 705083870
Phone: (800) 893-9698
Type: Mailing
5750 E BASELINE RD
MESA, AZ 852064806
Phone: (602) 833-6900
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2007-08-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20070807000555 | O | Clinic/Group Practice | AZ | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33324)
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