Individual provider Active NPI

Michael Dominick Diodato Jr., MD

  • Surgical Critical Care Physician
  • Phoenix, AZ
National Provider Identifier
1124270053
Registry record updated Nov 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
55156 Issued in AZ
Practice address
500 W Thomas Rd Ste 500
Phoenix, AZ 85013-4220
Phone
(602) 406-4000
Fax
(602) 406-6498
NPI assigned
Oct 22, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 036124370 IL
Surgery Physician 208600000X 051916 CT
Surgical Critical Care Physician 2086S0102X 051916 CT
Surgical Critical Care Physician 2086S0102X 55156 AZ Primary

Addresses

Primary practice location

500 W Thomas Rd Ste 500
Phoenix, AZ 85013-4220

Mailing address

500 W Thomas Rd Ste 500
Phoenix, AZ 85013-4220
Phone (602) 406-4000

Other identifiers 1

IdentifierTypeStateIssuer
001519164MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036124370ILMDCritical Care Medicine (Internal Medicine) Physician
051916CTMDSurgical Critical Care Physician

NPI Registry JSON

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

{
    "created_epoch": "1224633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543449600000",
    "number": "1124270053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W THOMAS RD STE 500",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134220",
            "telephone_number": "602-406-4000",
            "fax_number": "602-406-6498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W THOMAS RD STE 500",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134220",
            "telephone_number": "602-406-4000",
            "fax_number": "602-406-6498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIODATO",
        "first_name": "MICHAEL",
        "middle_name": "DOMINICK",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-22",
        "last_updated": "2018-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IL",
            "license": "036124370",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CT",
            "license": "051916",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "CT",
            "license": "051916",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "AZ",
            "license": "55156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001519164",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.