Individual provider Active NPI

Karen Patricia Gonsalves-Wetherell, MD

  • General Practice Physician
  • Glendale, AZ
National Provider Identifier
1033118393
Registry record updated Jul 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
27241 Issued in AZ
Practice address
5620 W Thunderbird Rd
F1
Glendale, AZ 85306-4636
Phone
(602) 938-6960
Fax
(602) 938-6069
NPI assigned
Jul 19, 2005
Last updated
Jul 8, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 27241 AZ Primary

Addresses

Primary practice location

5620 W Thunderbird Rd
F1
Glendale, AZ 85306-4636

Mailing address

5620 W Thunderbird Rd
F1
Glendale, AZ 85306-4636
Phone (602) 938-6960

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
I20101215001222 AZ Practitioner - Internal Medicine 0941498059 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
27241AZMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona Primary Care Physicians, LLC CurrentSince Apr 1, 2015 Accepting new patients
Summit Medical Group Arizona LLC Internal Medicine CurrentSince Aug 1, 2018 Accepting new patients

Locations

5620 W Thunderbird Rd
Ste B2
Glendale, AZ 85306
Phone (602) 547-9405

5620 W Thunderbird Rd
Ste F1
Glendale, AZ 85306
Phone (602) 938-6960

5620 W Thunderbird Rd
Ste G2
Glendale, AZ 85306
Phone (602) 938-3600

14541 W Indian School Rd
#600
Goodyear, AZ 85395
Phone (623) 535-5599

14050 N 83rd Ave
Ste 270
Peoria, AZ 85381

Interoperability endpoints

  • Direct secure messaging: karen.gonsalves-wetherell.1@19654.direct.athenahealth.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373241600000",
    "number": "1033118393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5620 W THUNDERBIRD RD",
            "address_2": "F1",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064636",
            "telephone_number": "602-938-6960",
            "fax_number": "602-938-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5620 W THUNDERBIRD RD",
            "address_2": "F1",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064636",
            "telephone_number": "602-938-6960",
            "fax_number": "602-938-6069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONSALVES-WETHERELL",
        "first_name": "KAREN",
        "middle_name": "PATRICIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-19",
        "last_updated": "2013-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AZ",
            "license": "27241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.