NPIMap

Individual provider Active NPI

Amanda Modesta Keyhani, MD

  • Internal Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1316993371
Registry record updated Dec 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
24512 Issued in AZ
Practice address
202 E Earll Drive
#150
Phoenix, AZ 85012
Phone
(602) 248-8258
Fax
(602) 248-8259
NPI assigned
May 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 24512 AZ Primary

Addresses

Primary practice location

202 E Earll Drive
#150
Phoenix, AZ 85012

Mailing address

202 E Earll Dr
#150
Phoenix, AZ 85012-2634
Phone (602) 248-8258

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
I20070208000246 AZ Practitioner - Internal Medicine 2062305535 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Ohio, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

202 E Earll Dr
Suite 150
Phoenix, AZ 85012-2636
Phone (602) 248-8258

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24512AZMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Greenway Urgent Care LLC Past Accepting new patients
Shea Urgent Care LLC Past Accepting new patients
Desert Ridge Urgent Care LLC Past Accepting new patients
Nextcare Arizona LLC Past Accepting new patients
Dana Landing Urgent Care LLC Past Accepting new patients
Chandler Urgent Care LLC Past Accepting new patients
Avondale Urgent Care LLC Past Accepting new patients
Pinnacle Medicine Inc. Past Accepting new patients
Nextcare Arizona I JV LLC Past Accepting new patients
Sun City Urgent Care LLC Past Accepting new patients
Glendale Urgent Care LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: amanda.modesta-keyhani.1@18519.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/18519/brand/1/csg/1/fhir/r4

Organizations & group practices 12

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354579200000",
    "number": "1316993371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E EARLL DR",
            "address_2": "#150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122634",
            "telephone_number": "602-248-8258",
            "fax_number": "602-248-8259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E EARLL DRIVE",
            "address_2": "#150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85012",
            "telephone_number": "602-248-8258",
            "fax_number": "602-248-8259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODESTA KEYHANI",
        "first_name": "AMANDA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2012-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "24512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.