Individual provider Active NPI

Michael C Kruer, M.D.

  • Neurodevelopmental Disabilities Physician
  • Phoenix, AZ
National Provider Identifier
1366640468
Registry record updated Oct 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurodevelopmental Disabilities PhysicianTaxonomy code 2084P0005X
License
8115 Issued in SD
Practice address
1919 E Thomas Rd
Phoenix, AZ 85016-7710
Phone
(602) 933-0970
NPI assigned
Jul 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurodevelopmental Disabilities Physician 2084P0005X 8115 SD Primary

Addresses

Primary practice location

1919 E Thomas Rd
Phoenix, AZ 85016-7710

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Other identifiers 1

IdentifierTypeStateIssuer
060528MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151009002370 AZ Practitioner - NeurologyPractitioner - Pediatric Medicine 8527230952 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8115SDMDNeurodevelopmental Disabilities Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Children'S Medical Group CurrentSince Sep 21, 2015 Accepting new patients
Phoenix Children'S Hospital CurrentSince Sep 21, 2015 Accepting new patients
Phoenix Children'S Hospital Hope Past Accepting new patients

Locations

3370 S Mercy Rd
Ste 214
Gilbert, AZ 85297

1919 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 933-0777

1919 E Thomas Rd
Bldg 2108
Phoenix, AZ 85016
Phone (602) 512-8030

Organizations & group practices 3

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": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571875200000",
    "number": "1366640468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 E THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850167710",
            "telephone_number": "602-933-0970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUER",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-10",
        "last_updated": "2019-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0005X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurodevelopmental Disabilities",
            "state": "SD",
            "license": "8115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060528",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.