Individual provider Active NPI

Todd J Alan, MD

  • Family Medicine Physician
  • Luke AFB, AZ
National Provider Identifier
1083620090
Registry record updated Jun 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
49059 Issued in AZ
Practice address
7219 N Litchfield Rd
Luke AFB, AZ 85309-1529
Phone
(623) 856-2273
NPI assigned
Jul 31, 2006
Last updated
Jun 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 23409 NE
Family Medicine Physician 207Q00000X 49059 AZ Primary

Addresses

Primary practice location

7219 N Litchfield Rd
Luke AFB, AZ 85309-1529

Mailing address

7219 N Litchfield Rd
Luke AFB, AZ 85309-1529
Phone (623) 856-2273

Other identifiers 1

IdentifierTypeStateIssuer
47055301100MedicaidNE

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
I20141222002672 AZ Order and Referring Only - Family PracticePractitioner - Family Practice 6709806763

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49059AZMDFamily Medicine Physician
23409NEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Urgent Care Clinic of Lincoln, P.C. Past Accepting new patients

Organizations & group practices 1

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": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1083620090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7219 N LITCHFIELD RD",
            "city": "LUKE AFB",
            "state": "AZ",
            "postal_code": "853091529",
            "telephone_number": "623-856-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7219 N LITCHFIELD RD",
            "city": "LUKE AFB",
            "state": "AZ",
            "postal_code": "853091529",
            "telephone_number": "623-856-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALAN",
        "first_name": "TODD",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "23409",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "49059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47055301100",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Luke AFB, AZ

Sources for this page

Verify at the official NPI Registry.