Individual provider Active NPI

Constance Tucker, DO

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1255391645
Registry record updated Dec 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3713 Issued in AZ
Practice address
6601 West Thomas Road
Phoenix, AZ 85033
Phone
(602) 243-7277
Fax
(623) 247-9742
NPI assigned
Mar 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2011

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 3713 AZ Primary

Addresses

Primary practice location

6601 West Thomas Road
Phoenix, AZ 85033

Mailing address

2702 North 3Rd Street
Suite 4020
Phoenix, AZ 85004-4608
Phone (602) 323-3344

Other identifiers 1

IdentifierTypeStateIssuer
809428MedicaidAZ

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
I20040420000191 AZ Practitioner - Family Practice 3072508829

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3713AZMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Park Health Center - Dental Past Accepting new patients
Mountain Park Health Center Past Accepting new patients
Equality Health at Home Inc Past Accepting new patients

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": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324425600000",
    "number": "1255391645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2702 NORTH 3RD STREET",
            "address_2": "SUITE 4020",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850044608",
            "telephone_number": "602-323-3344",
            "fax_number": "602-323-3496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 WEST THOMAS ROAD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85033",
            "telephone_number": "602-243-7277",
            "fax_number": "623-247-9742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "CONSTANCE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-28",
        "last_updated": "2011-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "3713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "809428",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.