NPIMap

Organization Active NPI

District Medical Group, Inc

  • Clinic/Center
  • Peoria, AZ
National Provider Identifier
1124667555
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
DISTRICT MEDICAL GROUP, INC
Practice address
15182 N 75TH Ave Ste 180
Peoria, AZ 85381-4722
Phone
(623) 487-3334
Fax
(623) 487-3656
NPI assigned
Jan 2, 2020
Organization subpart
Yes
Parent organization
DISTRICT MEDICAL GROUP, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Authorized official

Name
Teresa Cordeiro
Title
Director, Credentialing
Phone
(602) 470-5519

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

15182 N 75TH Ave Ste 180
Peoria, AZ 85381-4722

Mailing address

2929 E Thomas Rd
Phoenix, AZ 85016-8034
Phone (602) 470-5519

Other identifiers 1

IdentifierTypeStateIssuer
475747MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
District Medical Group Inc31 organizations share this tax ID, including this one
Part of
District Medical Group Inc

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1577923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1124667555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 E THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850168034",
            "telephone_number": "602-470-5519",
            "fax_number": "602-470-5064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15182 N 75TH AVE STE 180",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814722",
            "telephone_number": "623-487-3334",
            "fax_number": "623-487-3656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTRICT MEDICAL GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DISTRICT MEDICAL GROUP, INC",
        "enumeration_date": "2020-01-02",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "CORDEIRO",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "DIRECTOR, CREDENTIALING",
        "authorized_official_telephone_number": "602-470-5519"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "475747",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.