Individual provider Active NPI

Jaime R Gaitan, MD

  • Retina Specialist (Ophthalmology) Physician
  • Phoenix, AZ
National Provider Identifier
1275580573
Registry record updated Apr 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
License
40429 Issued in AZ
Practice address
1750 E Glendale Ave
Phoenix, AZ 85020-5505
Phone
(602) 242-4928
Fax
(602) 249-4813
NPI assigned
May 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 40429 AZ
Retina Specialist (Ophthalmology) Physician 207WX0107X 40429 AZ Primary

Addresses

Primary practice location

1750 E Glendale Ave
Phoenix, AZ 85020-5505

Mailing address

1750 E Glendale Ave
Phoenix, AZ 85020-5505
Phone (602) 242-4928

Other identifiers 1

IdentifierTypeStateIssuer
337652MedicaidAZ

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
I20080930000417 AZ Practitioner - Ophthalmology 9436154648 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of Miami, LM Miller School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2517 N Great Western Dr
Prescott Valley, AZ 86314-2597
Phone (602) 242-4928

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40429AZMDRetina Specialist (Ophthalmology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Retina Consultants, LTD. Retina Specialist CurrentSince Mar 27, 2024 Accepting new patients
District Medical Group, Inc CurrentSince Nov 1, 2014 Accepting new patients
District Medical Group, Inc Current Accepting new patients
District Medical Group, Inc Past Accepting new patients
Associated Retina Consultants, LTD. Ophthalmology Past Accepting new patients
Eyenet Triage, PLC Ophthalmology Past Accepting new patients

Locations

199 S Candy Ln
Ste 2A
Cottonwood, AZ 86326
Phone (928) 632-2883

900 N San Francisco St
Flagstaff, AZ 86001
Phone 928774032219

3513 S Mercy Rd
Gilbert, AZ 85297
Phone (420) 641-5400

1626 N Litchfield Rd
Ste 250
Goodyear, AZ 85395

1933 S Alma School Rd
Mesa, AZ 85210

302 W Main St
Payson, AZ 85541
Phone (928) 474-4126

8088 W Whitney Dr
Peoria, AZ 85345
Phone (602) 655-2000

15353 N 91st Ave
Peoria, AZ 85381

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

1750 E Glendale Ave
Phoenix, AZ 85020
Phone (602) 216-1144

2525 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 344-1015

2517 N Great Western Dr
Prescott Valley, AZ 86314
Phone 9284451341 ext. 239

Interoperability endpoints

  • Direct secure messaging: jgaitan110326@direct.valleywisehealth.org

Organizations & group practices 6

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": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491264000000",
    "number": "1275580573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 E GLENDALE AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850205505",
            "telephone_number": "602-242-4928",
            "fax_number": "602-249-4813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E GLENDALE AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850205505",
            "telephone_number": "602-242-4928",
            "fax_number": "602-249-4813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAITAN",
        "first_name": "JAIME",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2017-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "AZ",
            "license": "40429",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "AZ",
            "license": "40429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "337652",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.