Eduardo Antonio Espinoza Olortegui, M.D.
Individual provider Active NPI Surgery Physician · Newark, NJ
NPI 1033648985 · NPPES record last updated Apr 27, 2024
Key facts
- NPI
- 1033648985
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 71187 (AZ)
- Practice address
- 150 Bergen St Ste F-102
Newark, NJ 07103-2496 - Phone
- (973) 972-9573
- NPI assigned
- Jun 5, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Vascular Surgery
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- San Carlos Apache Healthcare Corporation
Phoenician Cardiac Care LLC
Abdul Memon MD PLLC
Practice addresses (Care Compare)
103 Medicine Way Rd
Peridot, AZ 85542-0787
Phone (928) 475-1400
2075 W Pecos Rd
Suite 1
Chandler, AZ 85224-5723
Phone (480) 776-2982
5882 S Hospital Dr
Suite 1
Globe, AZ 85501-9455
Phone (480) 256-1518
Hospital & facility affiliations
- Banner Desert Medical Center
- Cobre Valley Regional Medical Center
- San Carlos Apache Healthcare Corporation
Merit-based Incentive Payment System (MIPS)
- Final score
- 92.44 of 100
- Quality
- 100
- Promoting interoperability
- 96
- Improvement activities
- 40
- Cost
- 73.64
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Spinal fusion | 1-10 |
| Varicose vein removal | 1-10 |
| Leg revascularization (restoring blood flow) | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240507003045 | AZ | Practitioner - Vascular Surgery | 1658636840 | Reassigns benefits to 3 organizations |
| I20250605000628 | TX | Practitioner - Vascular Surgery | 1658636840 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoenix Neurological Institute, Inc | Vascular Surgery | Current |
Accepting new patients |
| Abdul Memon, MD, PLLC | Current |
Accepting new patients | |
| San Carlos Apache Healthcare Corporation | Current | Accepting new patients | |
| San Carlos Apache Healthcare Corporation | Current |
Accepting new patients | |
| Phoenician Cardiac Care LLC | Current |
Accepting new patients |
Locations
2075 W Pecos Rd
Ste 2
Chandler, AZ 85224
Phone (480) 219-6840
1343 N Alma School Rd
Ste 125135
Chandler, AZ 85224
2075 W Pecos Rd
Ste B1
Chandler, AZ 85224
Phone (480) 748-4238
2075 W Pecos Rd
Ste 1
Chandler, AZ 85224
Phone (480) 656-5711
1343 N Alma School Rd
Ste 295205
Chandler, AZ 85224
1343 N Alma School Rd
Ste 160
Chandler, AZ 85224
Phone (480) 444-7447
5882 S Hospital Dr
Ste 1
Globe, AZ 85501
Phone (928) 425-2474
103 Medicine Way Rd
Peridot, AZ 85542
Phone (928) 475-1200
2228 W Northern Ave
Ste B202
Phoenix, AZ 85021
Phone (480) 346-9522
10255 N 32nd St
Phoenix, AZ 85028
Phone (602) 258-7003
2228 W Northern Ave
Ste B210
Phoenix, AZ 85021
Phone (480) 444-7447
2224 W Northern Ave
Ste C212
Phoenix, AZ 85021
2226 W Northern Ave
Ste C212
Phoenix, AZ 85021
Phone (480) 444-7491
3185 N Windsong Dr
Prescott Vly, AZ 86314
Phone (928) 759-7009
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EHCDCD/Endpoint/EHCDCD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | 71187 | AZ | |
| Surgery Physician | 208600000X | 71187 | AZ | Yes |
Addresses
Primary practice location
150 Bergen St Ste F-102
Newark, NJ 07103-2496
Mailing address
150 Bergen St Ste Uh-F102
Newark, NJ 07103-2496
Phone (973) 972-6295
Other practice location 1
1501 N. Campbell Ave.
Tucson, AZ 85724
Phone (520) 626-7747
Other providers in Newark, NJ
- Marcelo Esguerra Jr.
- Aida Eshak
- Sarah Eskander
- Shelly Jecc Espejo
- Marling Susana Espinosa
- Maria C Espiritu-Fuller
- Lilia Espiritu
- Jonathan Esposito
- Rene B. Esquerre
- Anoush M Essajanian
All providers in Newark, NJ · Surgery Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.