Individual provider Active NPI

IV Godzdanker, M.D.

  • Emergency Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1104239540
Registry record updated Sep 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
54281 Issued in AZ
Practice address
2601 E Roosevelt St
Phoenix, AZ 85008-4973
Phone
(602) 344-5808
Fax
(602) 344-5907
NPI assigned
Jun 3, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 54281 AZ Primary

Addresses

Primary practice location

2601 E Roosevelt St
Phoenix, AZ 85008-4973

Mailing address

2601 E Roosevelt St
Phoenix, AZ 85008-4973

Other practice location 1

269 S Candy Ln
Cottonwood, AZ 86326-4158
Phone (928) 639-6172

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
I20170728000555 AZ Practitioner - Emergency Medicine 3779853445 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Flagstaff Emergency PhysiciansGroup PAC ID 2860380813, 43 clinicians

Practice addresses (Care Compare)

1200 N Beaver St
Flagstaff, AZ 86001-3118
Phone (928) 774-1693

Hospital & facility affiliations

  • Verde Valley Medical Center Hospital, Cottonwood, AZ, CCN 030007
  • Flagstaff Medical Center Hospital, Flagstaff, AZ, CCN 030023

Merit-based Incentive Payment System (MIPS)

Final score
76.21 of 100Reported as group
Quality
70.63
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
82.13 of 100Reported as group
Quality
66.85
Promoting interoperability
99
Improvement activities
40
Cost
74.4

Merit-based Incentive Payment System (MIPS)

Final score
95.59 of 100Reported as group
Quality
81.55
Promoting interoperability
100
Improvement activities
40
Cost
79.5

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
District Medical Group, Inc Current Accepting new patients
Flagstaff Emergency Physicians Emergency Medicine CurrentSince Jul 20, 2017 Accepting new patients
District Medical Group, Inc CurrentSince Sep 1, 2017 Accepting new patients
District Medical Group, Inc Emergency Medicine CurrentSince Sep 1, 2017 Accepting new patients

Locations

269 S Candy Ln
Cottonwood, AZ 86326
Phone (928) 634-2251

1600 W University Ave
Ste 215
Flagstaff, AZ 86001
Phone (928) 214-3930

1200 N Beaver St
Flagstaff, AZ 86001
Phone (928) 213-6235

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

5102 W Campbell Ave
Phoenix, AZ 85031
Phone (623) 848-5000

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

2601 E Roosevelt St
Ste 0D10
Phoenix, AZ 85008

3700 W State Route 89A
Sedona, AZ 86336
Phone (928) 204-3000

3700 W State Route 89A
Ste B
Sedona, AZ 86336
Phone (928) 204-4180

Interoperability endpoints

  • Direct secure messaging: igodzdanker78441@direct.valleywisehealth.org

Organizations & group practices 4

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": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600128000000",
    "number": "1104239540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 E ROOSEVELT ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850084973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 E ROOSEVELT ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850084973",
            "telephone_number": "602-344-5808",
            "fax_number": "602-344-5907"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "269 S Candy Ln",
            "address_purpose": "LOCATION",
            "city": "Cottonwood",
            "state": "AZ",
            "postal_code": "863264158",
            "country_code": "US",
            "telephone_number": "928-639-6172",
            "fax_number": "928-639-6682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GODZDANKER",
        "first_name": "IV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-03",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "54281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.