| Banner Alzheimer's Institute | |
|
2901 N Central Ave Ste 106 Phoenix AZ 85012-2700 | |
| (602) 747-4000 | |
| Not Available |
| Full Name | Banner Alzheimer's Institute |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2901 N Central Ave Ste 106, Phoenix, Arizona |
| Authorized Official Name and Position | Eric Reiman (CEO/CSO) |
| Authorized Official Contact | 6027474000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Banner Alzheimer's Institute 2901 N Central Ave Ste 160 Phoenix AZ 85012-2702 | Banner Alzheimer's Institute 2901 N Central Ave Ste 106 Phoenix AZ 85012-2700 Ph: (602) 747-4000 |
| NPI Number | 1013966712 |
|---|---|
| Provider Enumeration Date | 05/09/2006 |
| Last Update Date | 09/02/2025 |
| Certification Date | 09/02/2025 |
| Medicare PECOS PAC ID | 8527070101 |
|---|---|
| Medicare Enrollment ID | O20060623000043 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013966712 | NPI | - | NPPES |
| 092207 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | () | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | () | Primary |
| Provider Name | Michele M Grigaitis-reyes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497862379 PECOS PAC ID: 2466435128 Enrollment ID: I20050316000189 |
| Provider Name | Anthony Darrel Mosley |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1457303760 PECOS PAC ID: 7012973019 Enrollment ID: I20051117000095 |
| Provider Name | Gamal F Sidarous |
|---|---|
| Provider Type | Practitioner - Nuclear Medicine |
| Provider Identifiers | NPI Number: 1699731802 PECOS PAC ID: 0042220063 Enrollment ID: I20060504000327 |
| Provider Name | Peter J Sunenshine |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1487610937 PECOS PAC ID: 0749238848 Enrollment ID: I20060828000404 |
| Provider Name | Walter J Nieri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265488258 PECOS PAC ID: 8325139777 Enrollment ID: I20070814000568 |
| Provider Name | Christine M Belden |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821297367 PECOS PAC ID: 9032291976 Enrollment ID: I20080130000595 |
| Provider Name | Allison Perrin |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1992929624 PECOS PAC ID: 2264401389 Enrollment ID: I20081120000060 |
| Provider Name | Rishi K Gosalia |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174797286 PECOS PAC ID: 8820149511 Enrollment ID: I20090618000726 |
| Provider Name | Lori E Nisson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255562385 PECOS PAC ID: 6103964820 Enrollment ID: I20091117000311 |
| Provider Name | Sara S Dhanani |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1063614873 PECOS PAC ID: 3577704550 Enrollment ID: I20130802000677 |
| Provider Name | Meggan M Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912338526 PECOS PAC ID: 7517190531 Enrollment ID: I20140429000003 |
| Provider Name | Marina Mary Reade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124460795 PECOS PAC ID: 3476878851 Enrollment ID: I20150205001300 |
| Provider Name | David R Shprecher |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1679692594 PECOS PAC ID: 0648365650 Enrollment ID: I20151119002780 |
| Provider Name | Dev Ashish |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396256251 PECOS PAC ID: 0547528168 Enrollment ID: I20180102002679 |
| Provider Name | Ganesh Gopalakrishna |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891995262 PECOS PAC ID: 4183893951 Enrollment ID: I20180720002520 |
| Provider Name | Melissa MG Cardenas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982103586 PECOS PAC ID: 2264784453 Enrollment ID: I20181017000837 |
| Provider Name | Alireza Atri |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326038506 PECOS PAC ID: 7911084330 Enrollment ID: I20181109002542 |
| Provider Name | Po-heng Tsai |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1952532475 PECOS PAC ID: 9032380993 Enrollment ID: I20190214003190 |
| Provider Name | Barbara a Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528474350 PECOS PAC ID: 2860732542 Enrollment ID: I20190315000326 |
| Provider Name | Michelle Marie Faddoul-ptacek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548541253 PECOS PAC ID: 5294065231 Enrollment ID: I20190918000993 |
| Provider Name | Stephanie Dianne De Santiago |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497303028 PECOS PAC ID: 1658602081 Enrollment ID: I20191015003617 |
| Provider Name | Jeremy Pruzin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1962816249 PECOS PAC ID: 0042501090 Enrollment ID: I20200923001175 |
| Provider Name | Vivian Fajardo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407471543 PECOS PAC ID: 4385054428 Enrollment ID: I20201102000611 |
| Provider Name | Parichita Choudhury |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1598318677 PECOS PAC ID: 5890021786 Enrollment ID: I20201208000933 |
| Provider Name | Michaela Ann Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700368685 PECOS PAC ID: 3274935622 Enrollment ID: I20210708001180 |
| Provider Name | Pallavi Joshi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1750765442 PECOS PAC ID: 1759626260 Enrollment ID: I20210824002750 |
| Provider Name | Gerrie Lynn Jakobs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942946322 PECOS PAC ID: 8921482126 Enrollment ID: I20220908000009 |
| Provider Name | Lauren Perry Blake |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912640046 PECOS PAC ID: 4385029743 Enrollment ID: I20220921001063 |
| Provider Name | Dayra a Valentino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063292365 PECOS PAC ID: 6507213337 Enrollment ID: I20231115002631 |
| Provider Name | Carrie Langford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558137422 PECOS PAC ID: 1153771399 Enrollment ID: I20231229001230 |
| Provider Name | Pranav A. Pillai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063040954 PECOS PAC ID: 2466843560 Enrollment ID: I20240710003359 |
| Provider Name | Renee Elise Lydiard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144987793 PECOS PAC ID: 4183162167 Enrollment ID: I20240821004058 |
| Provider Name | Andrew Hiep Ho |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1194288688 PECOS PAC ID: 0547658312 Enrollment ID: I20250806004113 |
| Provider Name | Heba Al-sahlani |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1942970231 PECOS PAC ID: 2860882651 Enrollment ID: I20250812002998 |
| Provider Name | Juan a Serrano Salcedo |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1588238380 PECOS PAC ID: 9234630609 Enrollment ID: I20250827005109 |
| Provider Name | Holly Laub |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1609339860 PECOS PAC ID: 2769716091 Enrollment ID: I20250919001636 |
| Provider Name | Molly Ament |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013752237 PECOS PAC ID: 8022509710 Enrollment ID: I20251111000864 |
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