Individual provider Active NPI

David S Nathalang, D.O.

  • Pediatric Critical Care Medicine Physician
  • Tucson, AZ
National Provider Identifier
1174847255
Registry record updated May 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
005447 Issued in AZ
Practice address
1501 N Campbell Avenue
Tucson, AZ 85724
Phone
(520) 626-5485
Fax
(520) 626-6571
NPI assigned
Mar 18, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X 20A9613 CA
Pediatric Critical Care Medicine Physician 2080P0203X 005447 AZ Primary

Addresses

Primary practice location

1501 N Campbell Avenue
Tucson, AZ 85724

Mailing address

2701 E Elvira Rd
Tucson, AZ 85756-7124
Phone (520) 626-5485

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
I20100824000236 AZ Practitioner - Pediatric Medicine 7315061637 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A9613CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner-University Medical Group Family Medicine CurrentSince Jul 1, 2010 Accepting new patients
Banner-University Medical Group CurrentSince Jul 1, 2010 Accepting new patients
Banner - University Medical Center Tucson Campus LLC Past Accepting new patients

Locations

2800 E Ajo Way
Tucson, AZ 85713
Phone (520) 294-4471

1625 N Campbell Ave
Tucson, AZ 85719

1501 N Campbell Ave
Tucson, AZ 85724
Phone (520) 626-7747

2701 E Elvira Rd
Tucson, AZ 85756
Phone (520) 874-4024

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.

NPI Registry JSON

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

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369785600000",
    "number": "1174847255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 E ELVIRA RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857567124",
            "telephone_number": "520-626-5485",
            "fax_number": "520-626-6571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 N CAMPBELL AVENUE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85724",
            "telephone_number": "520-626-5485",
            "fax_number": "520-626-6571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NATHALANG",
        "first_name": "DAVID",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-18",
        "last_updated": "2013-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "CA",
            "license": "20A9613",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "AZ",
            "license": "005447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.