Individual provider Active NPI

Douglas John Carlon, MD

  • Vascular Surgery Physician
  • Flagstaff, AZ
National Provider Identifier
1396704680
Registry record updated Dec 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
29314 Issued in AZ
Practice address
1895 N Jasper Dr Ste 1
Flagstaff, AZ 86001-1632
Phone
(928) 773-2332
Fax
(623) 524-8959
NPI assigned
Mar 23, 2006
Last updated
Dec 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 29314 AZ Primary

Addresses

Primary practice location

1895 N Jasper Dr Ste 1
Flagstaff, AZ 86001-1632

Mailing address

2320 N 3Rd St
Phoenix, AZ 85004-1303
Phone (602) 649-2007

Other identifiers 1

IdentifierTypeStateIssuer
694704MedicaidAZ

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
I20040318001662 AZ Practitioner - Vascular SurgeryPractitioner - General Surgery 6305736687 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
University of Colorado School of Medicine, Denver, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arizona Advanced Surgery LLCGroup PAC ID 0547690166, 93 clinicians

Practice addresses (Care Compare)

6040 N 7TH St
Suite 105 106
Phoenix, AZ 85014-1842
Phone (602) 277-7430

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.9 of 100Reported as group
Promoting interoperability
94
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
84.12 of 100Reported as group
Quality
76.35
Promoting interoperability
99
Improvement activities
40
Cost
71.55

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29314AZMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Physician Specialists Arizona LLC CurrentSince Jun 1, 2014 Accepting new patients
Banner Physician Specialists Arizona LLC Current Accepting new patients
Arizona Advanced Surgery LLC Surgery CurrentSince Oct 6, 2023 Accepting new patients
Banner Physician Specialists Arizona LLC CurrentSince Jun 1, 2014 Accepting new patients
St. Joseph's Hospital and Medical Center PastSince Aug 30, 2020 Accepting new patients
Sjhmc Physician Services Past Accepting new patients

Locations

525 S Watson Rd
Ste 205
Buckeye, AZ 85326
Phone (623) 322-0323

1895 N Jasper Dr
Ste 1
Flagstaff, AZ 86001
Phone (928) 213-6527

13555 W McDowell Rd
Ste 204
Goodyear, AZ 85395
Phone (613) 512-4326

2945 S Dobson Rd
#2320N
Mesa, AZ 85202

13640 N Plaza del Rio Blvd
Peoria, AZ 85381
Phone (623) 876-3800

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

2320 N 3rd St
Phoenix, AZ 85004
Phone (602) 258-3262

3033 N Central Ave
Ste 610
Phoenix, AZ 85012
Phone (602) 266-1556

6040 N 7th St
Ste 105
Phoenix, AZ 85014
Phone (602) 277-7430

6040 N 7th St
Ste 105106
Phoenix, AZ 85014
Phone (602) 277-7430

9150 W Indian School Rd
Ste 107
Phoenix, AZ 85037
Phone (623) 266-8002

9305 W Thomas Rd
Ste 360
Phoenix, AZ 85037
Phone (623) 327-8200

9321 W Thomas Rd
Ste 325
Phoenix, AZ 85037
Phone (623) 936-5406

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

14416 W Meeker Blvd
Sun City West, AZ 85375
Phone (623) 583-5083

14416 W Meeker Blvd
Ste 360
Sun City West, AZ 85375

14420 W Meeker Blvd
Ste 200
Sun City West, AZ 85375
Phone (623) 388-3188

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IGJBCD

Organizations & group practices 7

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 6

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": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702857600000",
    "number": "1396704680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 N 3RD ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041303",
            "telephone_number": "602-649-2007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1895 N JASPER DR STE 1",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860011632",
            "telephone_number": "928-773-2332",
            "fax_number": "623-524-8959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLON",
        "first_name": "DOUGLAS",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AZ",
            "license": "29314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "694704",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.