Active NPI
James M Mick, MD
- Pediatrics Physician
- Prescott, AZ
National Provider Identifier
1336118926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 16159
- Practice address
- 2120 Centerpointe West Drive
Prescott, AZ 86301 - Phone
- (928) 443-1111
- Fax
- (928) 443-5554
- NPI assigned
- Mar 16, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 16159 | AZ | Primary |
Addresses
Primary practice location
2120 Centerpointe West Drive
Prescott, AZ 86301
Mailing address
2120 Centerpointe West Drive
Prescott, AZ 86301
Phone (928) 443-1111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 258097 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16159 | AZ | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210809600000",
"number": "1336118926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2120 CENTERPOINTE WEST DRIVE",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "86301",
"telephone_number": "928-443-1111",
"fax_number": "928-443-5554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2120 CENTERPOINTE WEST DRIVE",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "86301",
"telephone_number": "928-443-1111",
"fax_number": "928-443-5554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICK",
"first_name": "JAMES",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-16",
"last_updated": "2008-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AZ",
"license": "16159",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "258097",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.