NPIMap

Individual provider Active NPI

Ilya Katz, D.O.

  • Internal Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1104026319
Registry record updated Jul 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
005220 Issued in AZ
Practice address
11022 N 28TH Dr Ste 205
Phoenix, AZ 85029
Phone
(602) 971-0304
Fax
(602) 971-0305
NPI assigned
Jul 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 242526 NY
General Practice Physician 208D00000X 005220 AZ
Internal Medicine Physician 207R00000X 005220 AZ Primary

Addresses

Primary practice location

11022 N 28TH Dr Ste 205
Phoenix, AZ 85029

Mailing address

11022 N 28TH Dr Ste 205
Phoenix, AZ 85029-5635
Phone (602) 971-0304

Other identifiers 1

IdentifierTypeStateIssuer
437332MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090813000745 AZ Practitioner - Internal Medicine 1951469220 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wings of Hope Medical Services LLC 8 clinicians

Practice addresses (Care Compare)

11022 N 28TH Dr
Suite 270
Phoenix, AZ 85029-5639
Phone (602) 971-0304

Hospital & facility affiliations

  • Thema Health Services Home health agency, Phoenix, AZ, CCN 037202
  • Integrity Home Health Care Services, LLC Home health agency, Phoenix, AZ, CCN 037246
  • Inspiring Home Health, LLC Home health agency, Phoenix, AZ, CCN 037489
  • At Home Healthcare Home health agency, Peoria, AZ, CCN 037215
  • True Promise Home Health Inc Home health agency, Scottsdale, AZ, CCN 037814
  • Wings of Hope Hospice and Palliative Care, Inc. Hospice, Phoenix, AZ, CCN 031631

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wings of Hope Hospice and Palliative Care Inc., Current Accepting new patients
Wings of Hope Medical Services, LLC Internal Medicine CurrentSince May 14, 2016 Accepting new patients
Banner Sun City Medical Group Past Accepting new patients

Locations

11022 N 28th Dr
Ste 270
Phoenix, AZ 85029
Phone (602) 971-0304

11022 N 28th Dr
Ste 205
Phoenix, AZ 85029
Phone (602) 971-0304

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wings of Hope Hospice and Palliative Care, Inc.Phoenix, AZ, CCN 031631 Hospice W-2 Managing Employee (40%) Nov 24, 2014

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532390400000",
    "number": "1104026319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11022 N 28TH DR STE 205",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850295635",
            "telephone_number": "602-971-0304",
            "fax_number": "602-971-0305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11022 N 28TH DR STE 205",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85029",
            "telephone_number": "602-971-0304",
            "fax_number": "602-971-0305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATZ",
        "first_name": "ILYA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-25",
        "last_updated": "2018-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "242526",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AZ",
            "license": "005220",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "005220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "437332",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.