NPIMap

Individual provider Active NPI

Amir Ezzat Gerges, D.O

  • Nephrology Physician
  • Prescott, AZ
National Provider Identifier
1275764854
Registry record updated Jan 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
006747 Issued in AZ
Practice address
1000 Willow Creek Rd
Suite F
Prescott, AZ 86301-1645
Phone
(480) 610-6100
Fax
(480) 610-6189
NPI assigned
Jul 30, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 006747 AZ Primary

Addresses

Primary practice location

1000 Willow Creek Rd
Suite F
Prescott, AZ 86301-1645

Mailing address

2149 E Warner Rd
Suite 102
Tempe, AZ 85284-3494
Phone (480) 610-6100

Other identifiers 1

IdentifierTypeStateIssuer
038696MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150810001063 AZ Practitioner - Nephrology 6901035849 Reassigns benefits to 2 organizations
I20160217000835 TX Practitioner - Nephrology 6901035849 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Rutgers School of Dental Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southwest Kidney Institute PLCGroup PAC ID 8224930987, 100 clinicians

Practice addresses (Care Compare)

1000 Willow Creek Rd
Suite F
Prescott, AZ 86301-1645
Phone (480) 610-6100

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tuba City Regional Health Care Corporation CurrentSince Jan 14, 2016 Accepting new patients
Southwest Kidney Institute Scottsdale LLC Nephrology CurrentSince Aug 3, 2015 Accepting new patients
Tuba City Regional Health Care Corporation Internal Medicine CurrentSince Jan 14, 2016 Accepting new patients

Locations

337 E Coronado Rd
Ste 201
Phoenix, AZ 85004
Phone (602) 252-8081

2149 E Warner Rd
Ste 101
Tempe, AZ 85284
Phone (480) 610-6111

2149 E Warner Rd
Ste 102
Tempe, AZ 85284
Phone (623) 247-0808

Interoperability endpoints

  • Direct secure messaging: amir.gerges.1@2697.direct.athenahealth.com

Organizations & group practices 4

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1248912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484524800000",
    "number": "1275764854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2149 E WARNER RD",
            "address_2": "SUITE 102",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852843494",
            "telephone_number": "480-610-6100",
            "fax_number": "480-610-6189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 WILLOW CREEK RD",
            "address_2": "SUITE F",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011645",
            "telephone_number": "480-610-6100",
            "fax_number": "480-610-6189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERGES",
        "first_name": "AMIR",
        "middle_name": "EZZAT",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-30",
        "last_updated": "2017-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AZ",
            "license": "006747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038696",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.