Individual provider Active NPI

Dallyn Porter Udall, DO

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Gilbert, AZ
National Provider Identifier
1164088605
Registry record updated May 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
License
011544 Issued in AZ
Practice address
2940 E Banner Gateway Dr Ste 200-250
Gilbert, AZ 85234-2168
Phone
(602) 648-5444
Fax
(602) 772-3801
NPI assigned
May 9, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 20A19340 CA
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X 20A19340 CA
Student in an Organized Health Care Education/Training Program 390200000X
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X 011544 AZ Primary
Orthopaedic Surgery Physician 207X00000X 011544 AZ

Addresses

Primary practice location

2940 E Banner Gateway Dr Ste 200-250
Gilbert, AZ 85234-2168

Mailing address

PO Box 80217
Phoenix, AZ 85060-0217
Phone (602) 385-2115

Other practice location 1

10710 N Torrey Pines Rd
LA Jolla, CA 92037-1035
Phone (858) 554-7993

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, AZ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230216001823 CA Practitioner - Orthopedic Surgery 3971975152 Reassigns benefits to 1 organization
I20250409002284 AZ Practitioner - Orthopedic Surgery 3971975152 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic Specialists of North America PLLCGroup PAC ID 7719014505, 310 clinicians

Practice addresses (Care Compare)

1675 E Melrose St
Suite 101 103
Gilbert, AZ 85297-1001
Phone (602) 631-3161

Hospital & facility affiliations

  • Mercy Gilbert Medical Center Hospital, Gilbert, AZ, CCN 030119
  • Arizona Spine and Joint Hospital Hospital, Mesa, AZ, CCN 030107

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement44
Knee replacement58
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A19340CAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Orthopedic Specialists of North America, PLLC Orthopaedic Surgery CurrentSince Apr 1, 2025 Accepting new patients
Orthopedic Specialists of North America PLLC CurrentSince Apr 1, 2025 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 23, 2022 Accepting new patients
Orthopedic Specialists of North America, PLLC Orthopaedic Surgery Current Accepting new patients
Arizona Spine and Joint Hospital LLC Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 23, 2022 Accepting new patients

Locations

525 S Chandler Village Dr
Chandler, AZ 85226
Phone (480) 750-0303

2940 E Banner Gateway Dr
Ste 200250
Gilbert, AZ 85234

1675 E Melrose St
Gilbert, AZ 85297
Phone (480) 519-8100

1675 E Melrose St
Ste 101103
Gilbert, AZ 85297
Phone (602) 631-3161

2940 E Banner Gateway Dr
Ste 200
Gilbert, AZ 85234

2355 E Camelback Rd
Ste 325
Phoenix, AZ 85016
Phone (602) 772-3795

40601 N Gantzel Rd
Ste 103
San Tan Vly, AZ 85140

5620 E Bell Rd
Scottsdale, AZ 85254
Phone (602) 485-3050

10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000

Interoperability endpoints

  • Direct secure messaging: dallynudall@asjh.medalliesdirect.net
  • Direct secure messaging: dudall146552@direct.llu.edu

Organizations & group practices 7

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 2

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": "1557360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746144000000",
    "number": "1164088605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80217",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850600217",
            "telephone_number": "602-385-2115",
            "fax_number": "480-418-3323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 E BANNER GATEWAY DR STE 200-250",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342168",
            "telephone_number": "602-648-5444",
            "fax_number": "602-772-3801"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10710 N Torrey Pines Rd",
            "address_purpose": "LOCATION",
            "city": "LA Jolla",
            "state": "CA",
            "postal_code": "920371035",
            "country_code": "US",
            "telephone_number": "858-554-7993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UDALL",
        "first_name": "DALLYN",
        "middle_name": "PORTER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-09",
        "last_updated": "2025-05-02",
        "certification_date": "2025-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "20A19340",
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "CA",
            "license": "20A19340",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "AZ",
            "license": "011544",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AZ",
            "license": "011544",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

Verify at the official NPI Registry.