Individual provider Active NPI

Mandefro Mengistu Zerefa, MD

  • Internal Medicine Physician
  • Tucson, AZ
National Provider Identifier
1427148386
Registry record updated Jun 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
34847 Issued in AZ
Practice address
7383 E Tanque Verde Rd
Tucson, AZ 85715-3475
Phone
(520) 318-3434
Fax
(520) 318-3435
NPI assigned
Oct 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2014

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 34847 AZ Primary
Internal Medicine Physician 207R00000X D0057892 MD

Addresses

Primary practice location

7383 E Tanque Verde Rd
Tucson, AZ 85715-3475

Mailing address

PO Box 43130
Tucson, AZ 85733-3130
Phone (520) 722-3777

Other identifiers 1

IdentifierTypeStateIssuer
981490MedicaidAZ

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
I20051212000219 AZ Practitioner - Internal MedicinePractitioner - Hospitalist 4688664626 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arizona Inpatient Medicine Associates LLCGroup PAC ID 4183688344, 70 clinicians

Practice addresses (Care Compare)

5301 E Grant Rd
Tucson, AZ 85712-2805
Phone (520) 324-2775

7383 E Tanque Verde Rd
Tucson, AZ 85715-3475
Phone (520) 318-3434

Hospital & facility affiliations

  • Tucson Medical Center Hospital, Tucson, AZ, CCN 030006
  • Encompass Health Rehabilitation Institute of Tucso Inpatient rehabilitation facility, Tucson, AZ, CCN 033028

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0057892MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona Inpatient Medicine Associates LLC Internal Medicine CurrentSince Dec 15, 2005 Accepting new patients
Hospital Physician Services, LLLP Internal Medicine Past Accepting new patients
Tucson Medical Center Past Accepting new patients

Locations

7383 E Tanque Verde Rd
Tucson, AZ 85715
Phone (520) 318-3434

Organizations & group practices 3

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 2

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": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401926400000",
    "number": "1427148386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43130",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857333130",
            "telephone_number": "520-722-3777",
            "fax_number": "520-296-6224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7383 E TANQUE VERDE RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857153475",
            "telephone_number": "520-318-3434",
            "fax_number": "520-318-3435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZEREFA",
        "first_name": "MANDEFRO",
        "middle_name": "MENGISTU",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2014-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "34847",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0057892",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "981490",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.