Constantin Siclovan, M. D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

21719 Issued in AZ

Practice address

14973 W Bell Rd Ste 100
Surprise, AZ 85374-3878

Phone

(623) 815-2900

Fax

(623) 583-1319

NPI assigned

Aug 8, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GGDECA/Endpoint/GGDECA

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.

• Greater Phoenix Collaborative Care PC

  • Clinic/Center
  • Phoenix, AZ
  • NPI 1750686614
  Medicare reassignment NPD
• Surprise Health Center, PLLC

  • Family Medicine Physician
  • Surprise, AZ
  • NPI 1467563718

  Internal Medicine

  Medicare reassignment NPD
• Greater Phoenix Collaborative Care PC

  • Diagnostic Radiology Physician
  • Phoenix, AZ
  • NPI 1790581742
  NPD

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

{
    "created_epoch": "1186531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1164613675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-954-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14973 W BELL RD STE 100",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853743878",
            "telephone_number": "623-815-2900",
            "fax_number": "623-583-1319"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13613 W Camino Del Sol",
            "address_2": "Ste 5",
            "address_purpose": "LOCATION",
            "city": "Sun City West",
            "state": "AZ",
            "postal_code": "853754480",
            "country_code": "US",
            "telephone_number": "623-584-7154",
            "fax_number": "623-584-7194",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SICLOVAN",
        "first_name": "CONSTANTIN",
        "credential": "M. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-08",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "21719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Michelle Shumylo, OTR/L, BCP
• Korey Shute, PA-C
• Pamela Daly Sibeck, MA
• Christie Sibiga, AGACNP-BC
• Sherry Dawn Sic
• Azfar Aftab Siddiqui, DMD.,MSC
• Jennifer Lynn Silbor, BS SLP
• Silver House Arizona LLC
• Silver House Behavioral Health PC
• Silver House Healthcare LLC

• Internal Medicine Physician in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; 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.

Verify at the official NPI Registry.