Individual provider Active NPI

Dustin Kyle Baldwin

  • Family Nurse Practitioner
  • Snowflake, AZ
National Provider Identifier
1407534316
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
294738 Issued in AZ
Practice address
590 S Main St
Snowflake, AZ 85937-5228
Phone
(928) 536-7519
Fax
(928) 532-2139
NPI assigned
Jul 10, 2023
Last updated
Apr 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 294738 AZ Primary

Addresses

Primary practice location

590 S Main St
Snowflake, AZ 85937-5228

Mailing address

590 S Main St
Snowflake, AZ 85937-5228
Phone (928) 536-7519

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230912001393 AZ Practitioner - Nurse Practitioner 9133583081 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4951 S White Mountain Rd
BLDG a
Show Low, AZ 85901-7801
Phone (928) 537-6700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
294738AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Healthcare Medical Associates CurrentSince Sep 1, 2023 Accepting new patients
Summit Healthcare Association Current Accepting new patients
Summit Healthcare Medical Associates Current Accepting new patients
Summit Healthcare Medical Associates CurrentSince Sep 1, 2023 Accepting new patients
Summit Healthcare Association Past Accepting new patients

Locations

2200 E Show Low Lake Rd
Show Low, AZ 85901
Phone (928) 537-4375

4951 S White Mountain Rd
Bldg A
Show Low, AZ 85901
Phone (928) 532-3926

590 S Main St
Snowflake, AZ 85937
Phone (520) 536-7519

Interoperability endpoints

  • Direct secure messaging: dustinbaldwin@shrmcshma.allscriptsdirect.net

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": "1688947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1407534316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 S MAIN ST",
            "city": "SNOWFLAKE",
            "state": "AZ",
            "postal_code": "859375228",
            "telephone_number": "928-536-7519",
            "fax_number": "928-532-2139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 S MAIN ST",
            "city": "SNOWFLAKE",
            "state": "AZ",
            "postal_code": "859375228",
            "telephone_number": "928-536-7519",
            "fax_number": "928-532-2139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALDWIN",
        "first_name": "DUSTIN",
        "middle_name": "KYLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-10",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "294738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Snowflake, AZ

Sources for this page

Verify at the official NPI Registry.