John Nicholas Dement, M.D
Individual provider Active NPI Family Medicine Physician · Glendale, AZ
NPI 1235200767 · NPPES record last updated Jan 7, 2013
Key facts
- NPI
- 1235200767
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 29926 (AZ)
- Practice address
- 23825 N 36TH Dr
Glendale, AZ 85310-4171 - Phone
- (480) 297-5152
- Fax
- (877) 628-9505
- NPI assigned
- Nov 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 12
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Stanford University School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Winslow Indian Health Care Center Inc
Practice addresses (Care Compare)
500 Indiana Ave
Winslow, AZ 86047-2169
500 N Indiana Ave
Winslow, AZ 86047-2169
Phone (928) 289-4646
SWC Navajo Route 15 and 60
1 Medical Center Dr
Dilkon, AZ 86047-2169
Phone (928) 289-4646
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080919000216 | TX | Practitioner - Emergency Medicine |
1153217864 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29926 | AZ | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Winslow Indian Health Care Center, Inc | Current |
Accepting new patients | |
| Winslow Indian Health Care Center, Inc | Current |
Accepting new patients | |
| Dilkon Medical Center | Current | Accepting new patients | |
| Ringtail Emergency Physicians | Past | Accepting new patients | |
| Page Hospital | Past | Accepting new patients | |
| Stronghold Emergency Physicians | Past | Accepting new patients | |
| Payson Emergency Physicians, P.C. | Past | Accepting new patients | |
| Little Colorado Emergency Physicians LLC | Past | Accepting new patients | |
| Navajo Health Foundation-Sage Memorial Hospital Inc | Past |
Accepting new patients | |
| Emcare Physician Providers, Inc | Past | Accepting new patients | |
| Emcare Physician Providers, Inc | Past | Accepting new patients | |
| Mesa General Emergency Physicians, LLC | Past | Accepting new patients |
Locations
500 Indiana Ave
Winslow, AZ 86047
1501 N Williamson Ave
Winslow, AZ 86047
Phone (928) 289-4691
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 29926 | AZ | Yes |
Addresses
Primary practice location
23825 N 36TH Dr
Glendale, AZ 85310-4171
Mailing address
23825 N 36TH Dr
Glendale, AZ 85310-4171
Phone (480) 297-5152
Other providers in Glendale, AZ
- Shannon Deluna
- Deluxe Home LLC
- Jolley D Demaih
- Clint Demas
- Divino Demeis-Dewitt
- Anna Demos
- Elena Demyanova
- Chloe Ann Denaro
- Neil T Dende
- Nyzear Denga
All providers in Glendale, AZ · Family Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.