Active NPI
David Randeen Hoovestol, M.D.
- Family Medicine Physician
- Yuma, AZ
National Provider Identifier
1437183993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 22168
- Practice address
- 2400 S Avenue a
Yuma, AZ 85364-7127 - Phone
- (928) 336-7100
- Fax
- (928) 336-7508
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 22168 | AZ | Primary |
Addresses
Primary practice location
2400 S Avenue a
Yuma, AZ 85364-7127
Mailing address
PO Box 660969
Arcadia, CA 91066-0969
Phone (626) 447-0296
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 190538 | Medicaid | AZ | |
| XPY190972 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS PHS IHS Phoenix Area | Current | Accepting new patients |
Locations
401 Picacho Rd
Winterhaven, CA 92283
Phone (760) 572-4100
4100 W 150th St
Cleveland, OH 44135
Organizations & group practices 1
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": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214179200000",
"number": "1437183993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 660969",
"city": "ARCADIA",
"state": "CA",
"postal_code": "910660969",
"telephone_number": "626-447-0296",
"fax_number": "626-447-6057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 S AVENUE A",
"city": "YUMA",
"state": "AZ",
"postal_code": "853647127",
"telephone_number": "928-336-7100",
"fax_number": "928-336-7508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOOVESTOL",
"first_name": "DAVID",
"middle_name": "RANDEEN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2008-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "22168",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "190538",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "XPY190972",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Yuma, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.