Active NPI
Deanna Lynn Bullaro-Anderer, DO
- Obstetrics & Gynecology Physician
- Mesa, AZ
National Provider Identifier
1114991171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 3271
- Practice address
- 5304 E Southern Ave
Ste 110
Mesa, AZ 85206-3623 - Phone
- (480) 237-3040
- Fax
- (480) 237-3049
- NPI assigned
- Feb 15, 2006
- Last updated
- Jun 27, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 3271 | AZ | Primary |
Addresses
Primary practice location
5304 E Southern Ave
Ste 110
Mesa, AZ 85206-3623
Mailing address
PO Box 748860
Atlanta, GA 30374-8860
Phone (480) 237-3040
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 430653 | Other | AHCCCS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3271 | AZ | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Valley Obstetrics & Gynecology PLC | Obstetrics & Gynecology | 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.
-
- Obstetrics & Gynecology Physician
- Mesa, AZ
- NPI 1427154442
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687824000000",
"number": "1114991171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 748860",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303748860",
"telephone_number": "480-237-3040",
"fax_number": "480-237-3049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5304 E SOUTHERN AVE",
"address_2": "STE 110",
"city": "MESA",
"state": "AZ",
"postal_code": "852063623",
"telephone_number": "480-237-3040",
"fax_number": "480-237-3049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLARO-ANDERER",
"first_name": "DEANNA",
"middle_name": "LYNN",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-15",
"last_updated": "2023-06-27",
"certification_date": "2023-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "AZ",
"license": "3271",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS",
"identifier": "430653",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.