Active NPI
Demetra Evrigenis, RD
- Registered Dietitian
- Glendale, AZ
National Provider Identifier
1306561089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86291745
- Practice address
- 18001 N 79TH Ave Ste A12
Glendale, AZ 85308-8398 - Phone
- (623) 399-6825
- Fax
- (623) 505-3474
- NPI assigned
- Oct 5, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86291745 | CA | Primary |
Addresses
Primary practice location
18001 N 79TH Ave Ste A12
Glendale, AZ 85308-8398
Mailing address
18001 N 79TH Ave Ste A12
Glendale, AZ 85308-8398
Phone (623) 399-6825
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2027 W Division St
Suite 120
Chicago, IL 60622-9024
Phone (855) 552-5557
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86291745 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Health Loft PLLC | Dietitian, Registered | Current | Accepting new patients |
| Health Loft Services LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
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": "1664928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664928000000",
"number": "1306561089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18001 N 79TH AVE STE A12",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853088398",
"telephone_number": "623-399-6825",
"fax_number": "623-505-3474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18001 N 79TH AVE STE A12",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853088398",
"telephone_number": "623-399-6825",
"fax_number": "623-505-3474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVRIGENIS",
"first_name": "DEMETRA",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-05",
"last_updated": "2022-10-05",
"certification_date": "2022-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86291745",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.