ARIZONA INTEGRATIVE MEDICAL — NPI 1477358356 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers

CMS-1500 Box 24J / 33a • NPI

1477358356

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

363A00000X (CMS 97)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant

Box 32 Service Location & ZIP+4

14424 S CANVASBACK LN, BLUFFDALE, UT, 84065-1762

✓ 9-Digit EDI 837 ZIP+4 (84065-1762)

Practice Phone & Referral Fax

(801) 580-9690

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1477358356 (ARIZONA INTEGRATIVE MEDICAL) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1477358356` (NPI-2 Organization / Facility)
Provider / Legal Name	ARIZONA INTEGRATIVE MEDICAL
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant NUCC Code: `363A00000X` (Physician Assistant)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	14424 S CANVASBACK LN, BLUFFDALE, UT, 84065-1762
Practice Telephone / Fax	Tel: (801) 580-9690
Administrative Mailing Address	980 E PECOS RD STE 3, CHANDLER, AZ, 85225-2438
Enumeration & Last Sync	Enumerated: 2025-02-15 \| CMS Record Updated: 2025-02-15
Authorized Official	SHANNON WATT (owner, CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

14424 S CANVASBACK LN, BLUFFDALE, UT, 84065-1762

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Plain-English Taxonomy & CMS Crosswalk (363A00000X)

What Does Taxonomy Code 363A00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363A00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 97 (Physician Assistant)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physician Assistant for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ARIZONA INTEGRATIVE MEDICAL)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`111N00000X` — Chiropractor Plain English: Licensed & Credentialed Chiropractic Providers — Chiropractor	State: N/A \| License: `Verified` \| Primary: Secondary
`363A00000X` — Physician Assistant Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ARIZONA INTEGRATIVE MEDICAL (NPI #1477358356)