Pebble Creek Medical Group PLLC
NPI 1790213064ActiveOrganization· Internal Medicine· Goodyear, AZ
Internal Medicine in Goodyear, Arizona, registered in NPPES in May 2017. The authorized official on file is Sanjay Bommakanti, MD, Md/Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1790213064 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 31, 2017 |
| Last updated in NPPES | May 31, 2017 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Internal Medicine Primary | 207R00000X | 37252 | AZ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (AZ) |
|---|
Other Internal Medicine providers in Goodyear
- 1366212946
- 1710102272
- 1669426565
- 1790264802
- 1902448566
- 1689811630
- 1497325468
- 1982623542
- 1366478802
- 1215662564
- 1023891710
- 1871235077