NPIMap

Individual provider Active NPI

Afeworki Ocbaghiorgis Kidane, DO

  • Internal Medicine Physician
  • Chandler, AZ
National Provider Identifier
1326018557
Registry record updated Jun 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4458 Issued in AZ
Practice address
1985 E Chandler Blvd
Chandler, AZ 85225-5110
Phone
(602) 755-0800
Fax
(602) 560-2721
NPI assigned
Jan 23, 2006
Last updated
Jun 10, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromusculoskeletal Medicine & OMM Physician 204D00000X 4458 AZ
Internal Medicine Physician 207R00000X 4458 AZ Primary

Addresses

Primary practice location

1985 E Chandler Blvd
Chandler, AZ 85225-5110

Mailing address

3003 N Central Ave Ste 1175
Phoenix, AZ 85012-0002
Phone (888) 698-6727

Other identifiers 1

IdentifierTypeStateIssuer
3480230MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20250318002053 TX Practitioner - Internal Medicine 0547157984 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
West Virginia School of Osteopathic Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

17487 S Health Care Dr
Hu Hu Kam Memorial Hospital
Laveen, AZ 85339-0038
Phone (520) 550-6000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4458AZMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Gila River Health Care Corporation Current Accepting new patients
Gila River Health Care Corporation Current Accepting new patients
Gila River Health Care Corporation CurrentSince Feb 13, 2025 Accepting new patients
Gila River Health Care CurrentSince Feb 13, 2025 Accepting new patients
Emergency Medical Centre of Flint, Inc. Past Accepting new patients
Gold Star Medical LLC Past Accepting new patients
Med 97 LLC Past Accepting new patients
Newco Hatfield Medical Group PLLC Internal Medicine PastSince Feb 1, 2020 Accepting new patients
Dignity Community Care Past Accepting new patients
Clinica Familiar Mexicana I LLC Past Accepting new patients
Chandler Regional Medical Center Past Accepting new patients
Emergency Medical Centre of Flint Past Accepting new patients

Locations

17487 S Healthcare Dr
Laveen, AZ 85339
Phone (520) 550-6000

17487 S Healthcare Dr
#H
Laveen, AZ 85339
Phone (520) 550-6000

48203 W Farrell Rd
#H
Maricopa, AZ 85139
Phone (520) 568-3881

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654819200000",
    "number": "1326018557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 N CENTRAL AVE STE 1175",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850120002",
            "telephone_number": "888-698-6727",
            "fax_number": "602-564-6246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1985 E CHANDLER BLVD",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852255110",
            "telephone_number": "602-755-0800",
            "fax_number": "602-560-2721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDANE",
        "first_name": "AFEWORKI",
        "middle_name": "OCBAGHIORGIS",
        "name_prefix": "Mr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "AZ",
            "license": "4458",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "4458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3480230",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

Verify at the official NPI Registry.