Individual provider Active NPI

Raquel M. Mercado Sepulveda, MD

  • Obstetrics & Gynecology Physician
  • Tucson, AZ
National Provider Identifier
1104135433
Registry record updated Sep 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
46371 Issued in AZ
Practice address
1500 N Wilmot Rd Ste C260
Tucson, AZ 85712-4416
Phone
(520) 347-5662
Fax
(520) 347-5895
NPI assigned
Oct 5, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 46371 AZ Primary

Addresses

Primary practice location

1500 N Wilmot Rd Ste C260
Tucson, AZ 85712-4416

Mailing address

1500 N Wilmot Rd Ste C260
Tucson, AZ 85712-4416
Phone (520) 347-5662

Other identifiers 1

IdentifierTypeStateIssuer
702139MedicaidAZ

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
I20120804000016 AZ Practitioner - Obstetrics/Gynecology 5698921864

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
46371AZMDObstetrics & Gynecology Physician

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IGGHAA

NPI Registry JSON

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

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567641600000",
    "number": "1104135433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N WILMOT RD STE C260",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857124416",
            "telephone_number": "520-347-5662",
            "fax_number": "520-347-5895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N WILMOT RD STE C260",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857124416",
            "telephone_number": "520-347-5662",
            "fax_number": "520-347-5895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERCADO SEPULVEDA",
        "first_name": "RAQUEL",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-05",
        "last_updated": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "AZ",
            "license": "46371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "702139",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.