Providers Add Provider

Add Provider / Physician

Draft / In Progress

Onboard and configure new providers across your healthcare network. Complete all required sections to activate.

Saved just now

0% Complete

AI Assistant Suggestions Available

Based on Family Medicine specialty, we recommend 20-minute follow-ups and 40-minute new patient visits. Telehealth is enabled for multi-state care.

Basic Information

Personal details and contact information

In Progress

Add Photo

First Name *

Middle Name

Last Name *

Preferred Name

Suffix

Gender *

Date of Birth *

Pronouns

Provider Type *

Email *

Mobile Phone *

Employment Type

Start Date *

Professional Identity

NPI, taxonomy, and organizational details

In Progress

NPI Number *

Internal Provider ID

Taxonomy Code

Provider Group

Department

Clinical Title

Professional Bio

Recommended 50-150 words 38 words

Languages Spoken

English Spanish

Credentials & Licensing

Medical licenses, certifications, and verifications

In Progress

Medical Degree

Medical School

Graduation Year

State Licenses

State

License Number

Issue Date

Expiration Date *

Verified Verified via Nursys e-Notify

DEA Number

DEA Expiration

CAQH ID

Board Certifications

American Board of Family Medicine

Certified 2017 - Expires 2027

Active

Specialty & Clinical Scope

Clinical focus areas and service capabilities

Complete

Primary Specialty *

Secondary Specialty

Clinical Focus Areas

Preventive Care Chronic Disease Management Women's Health Pediatrics

Accepting New Patients Accepting Referrals Gender-Specific Care Only

Age Groups Served

Adults (18-64) Seniors (65+) Children (0-17)

Locations & Facility Access

Practice locations and facility permissions

Complete

Primary Location *

Healeo Medical Center – Scottsdale

7420 E. Pinnacle Peak Rd, Suite 100
Scottsdale, AZ 85255

Mon-Fri: 7AM-7PM Sat: 8AM-2PM

Secondary Locations

Healeo North Valley Clinic

Phoenix, AZ

Healeo Telehealth Network

Virtual Care

Scheduling & Availability

Weekly schedule, appointment types, and availability

In Progress

Weekly Availability

Time

Mon

Tue

Wed

Thu

Fri

Sat

Sun

8:00 AM

Available