Individual provider Active NPI

Thomas Robert Pena, D.O.

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1164620399
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R951 Issued in AZ
Practice address
1300 N 12TH St
Suite 605
Phoenix, AZ 85006-2848
Phone
(602) 239-4567
NPI assigned
Jul 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R951 AZ Primary

Addresses

Primary practice location

1300 N 12TH St
Suite 605
Phoenix, AZ 85006-2848

Mailing address

1300 N 12TH St
Suite 605
Phoenix, AZ 85006-2848
Phone (602) 239-2668

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
I20101215000395 AZ Practitioner - Family Practice 2062609118 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Arizona College of Osteopathic Medicine Mid Western University, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

13640 N Plaza del Rio Blvd
Peoria, AZ 85381-4846
Phone (623) 876-3800

1800 N Civic SQ
Goodyear, AZ 85395-2391
Phone (623) 465-6506

Hospital & facility affiliations

  • Emblem Home Health Phoenix Home health agency, Phoenix, AZ, CCN 037438
  • Banner Home Care-Arizona Home health agency, Mesa, AZ, CCN 037015

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R951AZMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Primary Care Physicians Arizona LLC CurrentSince Jul 18, 2012 Accepting new patients
Banner Primary Care Physicians Arizona LLC CurrentSince Jul 18, 2012 Accepting new patients
Banner Primary Care Physicians Arizona LLC Current Accepting new patients

Locations

1811 E McMurray Blvd
Casa Grande, AZ 85122
Phone (520) 374-2090

1800 N Civic Sq
Ste 200
Goodyear, AZ 85395
Phone (623) 465-6506

9780 S Estrella Pkwy
Goodyear, AZ 85338
Phone (623) 474-8101

1800 N Civic Sq
Ste 220
Goodyear, AZ 85395
Phone (623) 465-6506

5220 N Dysart Rd
Ste G174
Litchfield Park, AZ 85340

4860 N Litchfield Rd
Ste 102
Litchfield Park, AZ 85340
Phone (602) 774-1695

5220 N Dysart Rd
Ste 174
Litchfield Pk, AZ 85340
Phone (623) 535-9421

13640 N Plaza del Rio Blvd
Peoria, AZ 85381
Phone (623) 876-3800

9201 W Thomas Rd
Phoenix, AZ 85037
Phone (623) 327-4000

Organizations & group practices 3

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": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184025600000",
    "number": "1164620399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N 12TH ST",
            "address_2": "SUITE 605",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062848",
            "telephone_number": "602-239-2668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N 12TH ST",
            "address_2": "SUITE 605",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062848",
            "telephone_number": "602-239-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "THOMAS",
        "middle_name": "ROBERT",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-10",
        "last_updated": "2007-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "R951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.