Sparcc Professional Corporation is a medicare enrolled "Internal Medicine - Sports Medicine" provider in Tucson, Arizona. Their current practice location is
5199 E Farness Dr, Ste 101, Tucson, Arizona. You can reach out to their office (for appointments etc.) via phone at
(520) 222-8076.
Sparcc Professional Corporation is licensed to practice in Arizona (license number 49421) and it also participates in the medicare program. Sparcc Professional Corporation
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1003275413.
Healthcare Provider's Profile
| Full Name | Sparcc Professional Corporation |
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| Type | Facility |
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| Speciality | Internal Medicine - Sports Medicine |
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| Location | 5199 E Farness Dr, Tucson, Arizona |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1003275413
- Provider Enumeration Date: 02/12/2016
- Last Update Date: 04/20/2026
Medicare PECOS Information:
- PECOS PAC ID: 8820515539
- Enrollment ID: O20250506003405
Medical Identifiers
Medical identifiers for Sparcc Professional Corporation such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1003275413 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | (* (Not Available)) | Secondary |
| 207RS0010X | Internal Medicine - Sports Medicine | 49421 (Arizona) | Primary |
| 2080S0010X | Pediatrics - Sports Medicine | 49421 (Arizona) | Secondary |
| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| 225X00000X | Occupational Therapist | (* (Not Available)) | Secondary |
| 235Z00000X | Speech-language Pathologist | (* (Not Available)) | Secondary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Sparcc Professional Corporation acts as a billing entity for following providers:
| Provider Name | Mohammed Raheeb Mortazavi |
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| Provider Type | Practitioner - Pediatric Medicine |
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| Provider Identifiers | NPI Number: 1871740241
PECOS PAC ID: 8820240203
Enrollment ID: I20140814001227 |
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| Provider Name | Brett Cordyn Wood Dusenberry |
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| Provider Type | Practitioner - Sports Medicine |
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| Provider Identifiers | NPI Number: 1104274430
PECOS PAC ID: 6406219401
Enrollment ID: I20250612002103 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Sparcc Professional Corporation is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Sparcc Professional Corporation
5199 E Farness Dr Ste 101,
Tucson, AZ 85712-2262
Ph: (520) 548-4847 | Sparcc Professional Corporation
5199 E Farness Dr, Ste 101,
Tucson, AZ 85712-5617
Ph: (520) 222-8076 |
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