Individual provider Active NPI

Thomas P Porter, M.D.

  • Family Medicine Physician
  • Mesa, AZ
National Provider Identifier
1023094141
Registry record updated Mar 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14193 Issued in AZ
Practice address
1950 S Country Club Dr
Mesa, AZ 85210-6008
Phone
(480) 969-1446
Fax
(480) 969-9105
NPI assigned
Dec 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 14193 AZ Primary

Addresses

Primary practice location

1950 S Country Club Dr
Mesa, AZ 85210-6008

Mailing address

1950 S Country Club Dr
Mesa, AZ 85210-6008
Phone (480) 969-1446

Other identifiers 2

IdentifierTypeStateIssuer
1Z7322OtherAZHEALTHNET
AZ0835980OtherAZBCBS AZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100618000227 AZ Practitioner - Family Practice 7618007618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio State University College of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Banner Primary Care Physicians Arizona LLCGroup PAC ID 6406020155, 236 clinicians

Practice addresses (Care Compare)

1300 S Country Club Dr
Suite 3
Mesa, AZ 85210-5162
Phone (480) 827-5500

13640 N Plaza del Rio Blvd
Peoria, AZ 85381-4846
Phone (623) 876-3800

Hospital & facility affiliations

  • Banner Home Care-Arizona Home health agency, Mesa, AZ, CCN 037015

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Primary Care Physicians Arizona LLC CurrentSince Mar 1, 2020 Accepting new patients
Banner Primary Care Physicians Arizona LLC CurrentSince Mar 1, 2020 Accepting new patients
Banner Primary Care Physicians Arizona LLC Past Accepting new patients

Locations

17900 N Porter Rd
Maricopa, AZ 85138
Phone (520) 233-2500

1950 S Country Club Dr
Ste 101
Mesa, AZ 85210
Phone (480) 557-7474

1300 S Country Club Dr
Ste 3
Mesa, AZ 85210
Phone (480) 827-5500

13640 N Plaza del Rio Blvd
Peoria, AZ 85381
Phone (623) 876-3800

14416 W Meeker Blvd
Sun City West, AZ 85375
Phone (623) 583-5083

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269475200000",
    "number": "1023094141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 S COUNTRY CLUB DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106008",
            "telephone_number": "480-969-1446",
            "fax_number": "480-969-9105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 S COUNTRY CLUB DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106008",
            "telephone_number": "480-969-1446",
            "fax_number": "480-969-9105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "THOMAS",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2010-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "14193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "1Z7322",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS AZ",
            "identifier": "AZ0835980",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.