NPIMap

Organization Active NPI

Desert Ridge Medical Group

  • General Practice Physician
  • Phoenix, AZ
National Provider Identifier
1386133080
Registry record updated Oct 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
DESERT RIDGE MEDICAL GROUP
Practice address
21001 N Tatum Blvd Ste 78-1640
Phoenix, AZ 85050-5244
Phone
(480) 926-7800
Fax
(480) 926-2260
NPI assigned
May 8, 2018
Last updated
Oct 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2023

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

Authorized official

Name
Ellie Descalzo
Title
Credentialing Officer
Phone
(480) 926-7800

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Chiropractor 111N00000X NU
Physical Medicine & Rehabilitation Physician 208100000X NU
General Practice Physician 208D00000X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

21001 N Tatum Blvd Ste 78-1640
Phoenix, AZ 85050-5244

Mailing address

PO Box 6610
Chandler, AZ 85246-6610
Phone (480) 926-7800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180924002341 AZ Part B Supplier - Clinic/Group Practice 5991056350 Receives reassigned benefits from 13 practitioners
Practice locations: Phoenix, AZ
O20190904002792 AZ DME Supplier - Medical Supply Company 5991056350 Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697155200000",
    "number": "1386133080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6610",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852466610",
            "telephone_number": "480-926-7800",
            "fax_number": "480-926-2260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21001 N TATUM BLVD STE 78-1640",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850505244",
            "telephone_number": "480-926-7800",
            "fax_number": "480-926-2260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT RIDGE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-08",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A",
        "authorized_official_last_name": "DESCALZO",
        "authorized_official_first_name": "ELLIE",
        "authorized_official_title_or_position": "CREDENTIALING OFFICER",
        "authorized_official_telephone_number": "480-926-7800"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.