Individual provider Active NPI

Renuka B. Nigam, MD

  • Pediatrics Physician
  • Mesa, AZ
National Provider Identifier
1386691988
Registry record updated Sep 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
28287 Issued in AZ
Practice address
59 S Hibbert
Mesa, AZ 85210-1414
Phone
(480) 344-6226
Fax
(480) 344-6201
NPI assigned
May 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 28287 AZ Primary

Addresses

Primary practice location

59 S Hibbert
Mesa, AZ 85210-1414

Mailing address

2929 E Thomas Rd
Phoenix, AZ 85016-8034
Phone (602) 470-5000

Other identifiers 1

IdentifierTypeStateIssuer
547565MedicaidAZ

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
I20090916000596 AZ Practitioner - Pediatric MedicinePractitioner - Hematology/Oncology 6305992330 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28287AZMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
District Medical Group, Inc CurrentSince Jan 1, 2010 Accepting new patients
District Medical Group, Inc Current Accepting new patients
District Medical Group, Inc CurrentSince Jan 1, 2010 Accepting new patients
Liberty Child and Adolescent Health Services Past Accepting new patients
District Medical Group, Inc Family Medicine Past Accepting new patients
Alliance Community Healthcare, Inc. Past Accepting new patients

Locations

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

2929 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 470-5043

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

Interoperability endpoints

  • Direct secure messaging: rnigam5213@direct.valleywisehealth.org

Organizations & group practices 6

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": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316044800000",
    "number": "1386691988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 E THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850168034",
            "telephone_number": "602-470-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 S HIBBERT",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852101414",
            "telephone_number": "480-344-6226",
            "fax_number": "480-344-6201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIGAM",
        "first_name": "RENUKA",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-28",
        "last_updated": "2011-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "28287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "547565",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.