Individual provider Active NPI

Gina Marie Mathew, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Mesa, AZ
National Provider Identifier
1366731358
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
52289 Issued in AZ
Practice address
6424 E Broadway Rd Ste 105
Mesa, AZ 85206-1750
Phone
(623) 876-6960
NPI assigned
Mar 30, 2011
Last updated
Apr 23, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 52289 AZ Primary

Addresses

Primary practice location

6424 E Broadway Rd Ste 105
Mesa, AZ 85206-1750

Mailing address

1917 S Crismon Rd
Mesa, AZ 85209-6216
Phone (623) 876-6960

Other practice location 1

4375 E Irma Ln
Phoenix, AZ 85050-4312
Phone (623) 876-6960

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
I20160812001431 AZ Practitioner - EndocrinologyPractitioner - Internal Medicine 5698085660 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1917 S Crismon Rd
Banner Health Center
Mesa, AZ 85209-6216
Phone (480) 610-7100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
52289AZMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Physician Specialists Arizona LLC Current Accepting new patients
Banner Physician Specialists Arizona LLC CurrentSince Aug 1, 2020 Accepting new patients
Banner Physician Specialists Arizona LLC CurrentSince Aug 1, 2020 Accepting new patients
VHS Outpatient Clinics, Inc. CurrentSince Sep 12, 2016 Accepting new patients
VHS Outpatient Clinics, Inc. Internal Medicine CurrentSince Sep 12, 2016 Accepting new patients

Locations

5130 W Baseline Rd
Ste 102
Laveen, AZ 85339
Phone (602) 237-0039

1917 S Crismon Rd
Mesa, AZ 85209
Phone (480) 610-7100

6424 E Broadway Rd
Ste 105
Mesa, AZ 85206
Phone (480) 684-6487

9165 W Thunderbird Rd
Ste 200
Peoria, AZ 85381
Phone (623) 285-1120

2000 W Bethany Home Rd
Ste 200
Phoenix, AZ 85015
Phone (602) 246-5525

4375 E Irma Ln
Phoenix, AZ 85050
Phone (480) 890-5800

4524 N Maryvale Pkwy
Ste 220
Phoenix, AZ 85031
Phone (623) 535-4582

6036 N 19th Ave
Ste 505
Phoenix, AZ 85015
Phone (602) 249-0839

6036 N 19th Ave
Ste 506
Phoenix, AZ 85015
Phone (602) 246-5525

10401 W Thunderbird Blvd
Sun City, AZ 85351
Phone (623) 815-7690

Organizations & group practices 5

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 3

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": "1301443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1366731358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1917 S CRISMON RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852096216",
            "telephone_number": "623-876-6960",
            "fax_number": "623-285-2624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6424 E BROADWAY RD STE 105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061750",
            "telephone_number": "623-876-6960"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4375 E Irma Ln",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850504312",
            "country_code": "US",
            "telephone_number": "623-876-6960",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "GINA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-30",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "AZ",
            "license": "52289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.