MMGL, LLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

29719 Issued in AZ

Legal business name

MMGL, LLC

Doing business as

Five Star Medical Clinic

Practice address

2175 N. Alma School Rd.
Suite a- 104
Chandler, AZ 85224

Phone

(480) 275-4415

Fax

(480) 275-4577

NPI assigned

Feb 22, 2008

Reactivated

Feb 19, 2020

Last updated

Feb 19, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Maria Manuela Gonzalez-Landestoy, MDNPI 1568520500

Title

Owner/Physician

Phone

(480) 275-4415

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• FIVE STAR MEDICAL CLINIC Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8772/brand/1/csg/1/fhir/r4

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Maria Manuela Gonzalez-Landestoy, MD

  • Internal Medicine Physician
  • Chandler, AZ
  • NPI 1568520500
  Medicare reassignment NPD Authorized official
• Maria Guadalupe Santos-Rojo, PA

  • Medical Physician Assistant
  • Chandler, AZ
  • NPI 1912540378
  Medicare reassignment
• Gloria A Estrada, MD

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1932171915
  NPD (past)
• Pedro Pablo Ortiz, MD

  • Cardiovascular Disease Physician
  • Chandler, AZ
  • NPI 1659463362
  NPD (past)

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

{
    "created_epoch": "1203638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1093984171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2175 N. ALMA SCHOOL RD.",
            "address_2": "SUITE A- 104",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "85224",
            "telephone_number": "480-275-4415",
            "fax_number": "480-275-4577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2175 N. ALMA SCHOOL RD.",
            "address_2": "SUITE A- 104",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "85224",
            "telephone_number": "480-275-4415",
            "fax_number": "480-275-4577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMGL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-22",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "deactivation_date": "2017-05-03",
        "reactivation_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ-LANDESTOY",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "MANUELA",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "480-275-4415",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "AZ",
            "license": "29719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ BC/BS",
            "identifier": "0744170",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "Z78260",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "632697",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FIVE STAR MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FIVE STAR MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Preferred Provider Organization in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Preferred Provider Organization in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.