NPIMap

Individual provider Active NPI

Christopher Jordan Miedema, M.D.

  • Emergency Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1255747432
Registry record updated May 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
53920 Issued in AZ
Practice address
645 E Missouri Ave Ste 300
Phoenix, AZ 85012-1351
Phone
(480) 500-2540
Fax
(623) 201-7954
NPI assigned
Jul 8, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 125.064907 IL
Emergency Medicine Physician 207P00000X 53920 AZ Primary

Addresses

Primary practice location

645 E Missouri Ave Ste 300
Phoenix, AZ 85012-1351

Mailing address

645 E Missouri Ave Ste 300
Phoenix, AZ 85012-1351
Phone (480) 500-2540

Other practice location 1

701 N 1st St
Springfield, IL 62702-3757
Phone (217) 545-3518

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170814001796 AZ Practitioner - Emergency Medicine 1557654738 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Southern Illinois University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Professional Services PCGroup PAC ID 6901707272, 107 clinicians
Tec Emergency Physicians of Arizona, LLCGroup PAC ID 6204256084, 155 clinicians

Practice addresses (Care Compare)

1111 E McDowell Rd
Phoenix, AZ 85006-2612
Phone (954) 939-5000

9130 E Elliot Rd
Mesa, AZ 85212-9675
Phone (888) 732-3317

Hospital & facility affiliations

  • Banner - University Medical Center Phoenix Hospital, Phoenix, AZ, CCN 030002
  • Banner Estrella Medical Center Hospital, Phoenix, AZ, CCN 030115
  • Banner Goldfield Medical Center Hospital, Apache Junction, AZ, CCN 030134
  • Dignity Health - Arizona General Hospital Hospital, Laveen, AZ, CCN 030136
  • Dignity Health Arizona General Hospital Hospital, Mesa, AZ, CCN 030139

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53920AZMDEmergency Medicine Physician
125.064907ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Professional Services PC Emergency Medicine Current Accepting new patients
Banner - University Hospital Based Physicians LLC CurrentSince Mar 1, 2020 Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Mar 1, 2020 Accepting new patients
Tec Emergency Physicians of Arizona, LLC CurrentSince Dec 14, 2023 Accepting new patients
Emergency Professional Services PC Emergency Medicine CurrentSince Jul 1, 2017 Accepting new patients
Banner Hospital Based Physicians Arizona LLC Current Accepting new patients
Banner - University Hospital Based Physicians LLC CurrentSince Mar 1, 2020 Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Mar 1, 2020 Accepting new patients
Emergency Professional Services PC Emergency Medicine CurrentSince Jul 1, 2017 Accepting new patients

Locations

2050 W Southern Ave
Apache Junction, AZ 85120
Phone (480) 237-3200

7171 S 51st Ave
Laveen, AZ 85339
Phone (623) 584-5100

9130 E Elliot Rd
Mesa, AZ 85212
Phone (480) 410-4500

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

645 E Missouri Ave
Ste 300
Phoenix, AZ 85012
Phone (602) 262-8917

9201 W Thomas Rd
Phoenix, AZ 85037
Phone (623) 327-4000

37000 N Gantzel Rd
San Tan Valley, AZ 85140
Phone (480) 394-4000

1419 W Hunt Hwy
San Tan Vly, AZ 85143
Phone (480) 245-4300

5125 S Rural Rd
Tempe, AZ 85282
Phone (480) 306-8780

Organizations & group practices 9

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 24

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1404777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1255747432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 E MISSOURI AVE STE 300",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121351",
            "telephone_number": "480-500-2540",
            "fax_number": "623-201-7954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 E MISSOURI AVE STE 300",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121351",
            "telephone_number": "480-500-2540",
            "fax_number": "623-201-7954"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 N 1st St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627023757",
            "country_code": "US",
            "telephone_number": "217-545-3518",
            "fax_number": "217-545-2711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIEDEMA",
        "first_name": "CHRISTOPHER",
        "middle_name": "JORDAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-08",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "125.064907",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "53920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.