Individual provider Active NPI

Ijeoma Nnenna Kalu, MD

  • Internal Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1164163697
Registry record updated Sep 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
76011 Issued in AZ
Practice address
1300 N 12TH St Ste 508
Phoenix, AZ 85006-2849
Phone
(602) 839-3927
Fax
(602) 839-4233
NPI assigned
Apr 6, 2022
Last updated
Sep 22, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X A207564 CA
Internal Medicine Physician 207R00000X 76011 AZ Primary

Addresses

Primary practice location

1300 N 12TH St Ste 508
Phoenix, AZ 85006-2849

Mailing address

5555 W Thunderbird Rd
Glendale, AZ 85306-4622
Phone (602) 865-5555

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
I20250822002447 AZ Practitioner - Internal Medicine 8224561824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5555 W Thunderbird Rd
Glendale, AZ 85306-4622
Phone (602) 865-5555

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Aug 8, 2025 Accepting new patients
Banner Hospital Based Physicians Arizona LLC Current Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Aug 8, 2025 Accepting new patients
Banner Thunderbird Medical Center Past Accepting new patients

Locations

5555 W Thunderbird Rd
Glendale, AZ 85306
Phone (602) 588-5555

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1649203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790035200000",
    "number": "1164163697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 W THUNDERBIRD RD",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064622",
            "telephone_number": "602-865-5555",
            "fax_number": "602-839-4233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N 12TH ST STE 508",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062849",
            "telephone_number": "602-839-3927",
            "fax_number": "602-839-4233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALU",
        "first_name": "IJEOMA",
        "middle_name": "NNENNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-06",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A207564",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "76011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.