Individual provider Active NPI

Pavan Kumar Tiyyagura, MD

  • Hospitalist Physician
  • Mesa, AZ
National Provider Identifier
1366757361
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
43692 Issued in AZ
Practice address
1400 S Dobson Road
Attn Amanda Gump/Hospitalists
Mesa, AZ 85202
Phone
(480) 543-2034
Fax
(480) 543-2647
NPI assigned
Aug 13, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 43692 AZ
Hospitalist Physician 208M00000X 43692 AZ Primary

Addresses

Primary practice location

1400 S Dobson Road
Attn Amanda Gump/Hospitalists
Mesa, AZ 85202

Mailing address

1900 N Higley Road
Attn Amanda Gump/Hospitalists
Gilbert, AZ 85234
Phone (480) 543-2034

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
I20111208000473 AZ Practitioner - Internal MedicinePractitioner - Hospitalist 8820262470 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Banner Hospital Based Physicians Arizona LLCGroup PAC ID 3274782487, 636 clinicians

Practice addresses (Care Compare)

37000 N Gantzel Rd
San Tan Valley, AZ 85140-7303
Phone (480) 394-4000

Hospital & facility affiliations

  • Banner Desert Medical Center Hospital, Mesa, AZ, CCN 030065

Merit-based Incentive Payment System (MIPS)

Final score
83.7 of 100Reported as group
Quality
64.97
Promoting interoperability
98
Improvement activities
40
Cost
69.88

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pioneer Hospitalists, PLLC Internal Medicine CurrentSince Jun 1, 2019 Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Sep 1, 2020 Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Sep 1, 2020 Accepting new patients
Banner Hospital Based Physicians Arizona LLC Current Accepting new patients
Banner Desert Medical Center Past Accepting new patients

Locations

3115 S Price Rd
Chandler, AZ 85248
Phone (480) 855-4011

1900 N Higley Rd
Gilbert, AZ 85234
Phone (480) 543-2000

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

6644 E Baywood Ave
Mesa, AZ 85206
Phone (480) 321-2000

6750 E Baywood Ave
Mesa, AZ 85206
Phone (480) 854-5000

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

37000 N Gantzel Rd
San Tan Valley, AZ 85140
Phone (480) 394-4000

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1281657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1366757361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 N HIGLEY ROAD",
            "address_2": "ATTN AMANDA GUMP/HOSPITALISTS",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85234",
            "telephone_number": "480-543-2034",
            "fax_number": "480-543-2647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S DOBSON ROAD",
            "address_2": "ATTN AMANDA GUMP/HOSPITALISTS",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85202",
            "telephone_number": "480-543-2034",
            "fax_number": "480-543-2647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIYYAGURA",
        "first_name": "PAVAN",
        "middle_name": "KUMAR",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-13",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "43692",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "AZ",
            "license": "43692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.