Active NPI
Teresa Dean Malcolm, M.D.
- Obstetrics & Gynecology Physician
- Surprise, AZ
National Provider Identifier
1346414422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 40361
- Practice address
- 13995 W Statler Blvd
Surprise, AZ 85374-5501 - Phone
- (623) 478-3100
- NPI assigned
- Apr 18, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 81716 | AZ | |
| Obstetrics & Gynecology Physician | 207V00000X | 40361 | AZ | Primary |
Addresses
Primary practice location
13995 W Statler Blvd
Surprise, AZ 85374-5501
Mailing address
13995 W Statler Blvd
Surprise, AZ 85374-5501
Phone (623) 478-3100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 81716 | Other | AZ | TRAINING PERMIT |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 81716 | AZ | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TDM Medical Consulting, LLC | Current | Accepting new patients | |
| Banner Sun City Medical Group | 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.
-
- Gynecology Physician
- Phoenix, AZ
- NPI 1629937701
-
- Multi-Specialty Clinic/Center
- Sun City, AZ
- NPI 1902067200
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447286400000",
"number": "1346414422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13995 W STATLER BLVD",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853745501",
"telephone_number": "623-478-3100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13995 W STATLER BLVD",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853745501",
"telephone_number": "623-478-3100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALCOLM",
"first_name": "TERESA",
"middle_name": "DEAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-18",
"last_updated": "2015-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "AZ",
"license": "81716",
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "AZ",
"license": "40361",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRAINING PERMIT",
"identifier": "81716",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Surprise, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.