Individual provider Active NPI

Mayy Shaaban Deadrick, M.D.

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1194741074
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
21300 Issued in AZ
Practice address
4545 E Shea Blvd Ste 130
Phoenix, AZ 85028-3061
Phone
(480) 292-9532
Fax
(480) 664-3482
NPI assigned
Jul 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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 21300 AZ Primary

Addresses

Primary practice location

4545 E Shea Blvd Ste 130
Phoenix, AZ 85028-3061

Mailing address

4545 E Shea Blvd Ste 130
Phoenix, AZ 85028-3061
Phone (480) 292-9532

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
I20100305000250 AZ Practitioner - Family Practice 3476449869 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Manzanita Medical PLLCGroup PAC ID 6608147574, 2 clinicians

Practice addresses (Care Compare)

4545 E Shea Blvd
Suite 130
Phoenix, AZ 85028-3061
Phone (480) 292-9532

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.54 of 100Reported as individual
Quality
86.18
Promoting interoperability
100
Improvement activities
40
Cost
62.28

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Manzanita Medical PLLC Family Medicine CurrentSince Sep 1, 2017 Accepting new patients

Locations

10585 N Tatum Blvd
Ste D134
Paradise Vly, AZ 85253
Phone (480) 292-9532

4545 E Shea Blvd
Ste 130
Phoenix, AZ 85028
Phone (480) 292-9532

Interoperability endpoints

  • Direct secure messaging: mayy.deadrick.1@16225.direct.athenahealth.com

Organizations & group practices 1

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 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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681776000000",
    "number": "1194741074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4545 E SHEA BLVD STE 130",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850283061",
            "telephone_number": "480-292-9532",
            "fax_number": "602-224-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 E SHEA BLVD STE 130",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850283061",
            "telephone_number": "480-292-9532",
            "fax_number": "480-664-3482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEADRICK",
        "first_name": "MAYY",
        "middle_name": "SHAABAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "21300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.