Metro Infectious Disease Consultants, LLC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

Legal business name

METRO INFECTIOUS DISEASE CONSULTANTS, LLC

Practice address

13657 W McDowell Rd
Suite 118
Goodyear, AZ 85395-2601

Phone

(623) 328-7794

Fax

(623) 328-7932

NPI assigned

Mar 6, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Tara Kowalski

Title

Credentialing Manager

Phone

(888) 220-6432

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MIDC, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Metro Infectious Disease Consultants, LLC

  • Infectious Disease Physician
  • Burr Ridge, IL
  • NPI 1235125717

  O20170712003292

  Same enrollment

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/1b768eee-dd17-4e01-8b1e-f5330ffd0ffa/

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

{
    "created_epoch": "1362528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1073854600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MCCLINTOCK DR",
            "address_2": "SUITE 202",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270871",
            "telephone_number": "888-220-6432",
            "fax_number": "630-734-4715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13657 W MCDOWELL RD",
            "address_2": "SUITE 118",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952601",
            "telephone_number": "623-328-7794",
            "fax_number": "623-328-7932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO INFECTIOUS DISEASE CONSULTANTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-06",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KOWALSKI",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "888-220-6432",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "780223",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIDC, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elena Mendez, FNP-C
• Tushar Menon, MD
• Kelli Ann Mercado, PA
• Jenny Mercer, LAC
• Erica Merriweather
• Shelby Carrera Meyer
• Michael Davis DC LLC
• Bobbi Michels, PT
• Midwest Anesthesia Group PC
• Jeniffer Mijares, LPC

• Infectious Disease Physician in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Infectious Disease Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.