Individual provider Active NPI

Philip C. Kaczar, M.D.

  • Internal Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1235189077
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
26301 Issued in AZ
Practice address
9801 N Metro Pkwy E
Phoenix, AZ 85051-1513
Phone
(602) 249-0115
Fax
(602) 249-0838
NPI assigned
May 11, 2006
Last updated
Nov 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 26301 AZ Primary

Addresses

Primary practice location

9801 N Metro Pkwy E
Phoenix, AZ 85051-1513

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 838-8265

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
I20100106000680 AZ Practitioner - Internal Medicine 1153462601 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Loyola University of Chicago, Stritch School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

5830 N 19TH Ave
Phoenix, AZ 85015-2494
Phone (602) 336-1966

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26301AZMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Phoenix Collaborative Care PC CurrentSince Jan 5, 2019 Accepting new patients
Greater Phoenix Collaborative Care PC CurrentSince Jan 5, 2019 Accepting new patients

Locations

1501 S Yale St
Ste 150
Flagstaff, AZ 86001
Phone (928) 527-4325

2001 N 4th St
Flagstaff, AZ 86004
Phone (928) 526-5020

5830 N 19th Ave
Phoenix, AZ 85015
Phone (602) 249-0115

8041 N Black Canyon Hwy
Phoenix, AZ 85021
Phone (602) 249-0115

8041 N Black Canyon Hwy
Ste I
Phoenix, AZ 85021

9801 N Metro Pkwy E
Phoenix, AZ 85051
Phone (602) 249-0115

Interoperability endpoints

  • Direct secure messaging: pkaczar113912@westdirect.optum.com

Organizations & group practices 2

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 5

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1235189077",
    "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": "702-838-8265",
            "fax_number": "702-804-3788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9801 N METRO PKWY E",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850511513",
            "telephone_number": "602-249-0115",
            "fax_number": "602-249-0838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACZAR",
        "first_name": "PHILIP",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "26301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.