NPIMap

Individual provider Active NPI

Mary Michele Wahbah, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Phoenix, AZ
National Provider Identifier
1447454046
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
44522 Issued in AZ
Practice address
424 S 56TH St Ste 110
Phoenix, AZ 85034-2177
Phone
(602) 685-5211
Fax
(602) 685-5325
NPI assigned
Jun 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 44522 AZ Primary

Addresses

Primary practice location

424 S 56TH St Ste 110
Phoenix, AZ 85034-2177

Mailing address

PO Box 42210
Phoenix, AZ 85080-2210
Phone (623) 266-7770

Other practice location 1

424 S 56th St Ste 120
Phoenix, AZ 85034-2177
Phone (602) 685-5211

Other practice location 2

1955 W Frye Rd
Chandler, AZ 85224-6282
Phone (602) 685-5211

Other identifiers 2

IdentifierTypeStateIssuer
2790078981OtherMYUTMB 2790078981-COMMERCIAL NUMBER
619361MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110616000214 AZ Practitioner - Pathology 1254518434 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Texas Medical Branch at Galveston, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clin-Path PathologyGroup PAC ID 5193717866, 30 clinicians

Practice addresses (Care Compare)

1301 S Crimson Rd
Mesa, AZ 85209-3767
Phone (602) 685-5166

13677 W McDowell Rd
Goodyear, AZ 85395-2635
Phone (602) 685-5166

1500 S Mill Ave
Tempe, AZ 85281-6699
Phone (602) 685-5166

18701 N 67TH Ave
Glendale, AZ 85308-7100
Phone (602) 685-5166

1955 W Frye Rd
Chandler, AZ 85224-6282
Phone (602) 685-5166

2000 W Bethany Home Rd
Phoenix, AZ 85015-2443
Phone (602) 685-5166

3555 S Val Vista Dr
Gilbert, AZ 85297-7323
Phone (602) 685-5166

3929 E Bell Rd
Phoenix, AZ 85032-2112
Phone (602) 685-5166

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.75 of 100Reported as group
Quality
75
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
78.75 of 100Reported as group
Quality
75
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Exceptional Physicians Group Yuma Hospital PLLC CurrentSince Oct 24, 2024 Accepting new patients
Exceptional Physicians Group Prescott Hospital PLLC CurrentSince Mar 14, 2025 Accepting new patients
Exceptional Physicians Group Arizona PLLC CurrentSince Oct 24, 2024 Accepting new patients
Pathology Specialist of Arizona, LLP Anatomic Pathology & Clinical Pathology CurrentSince Jul 18, 2011 Accepting new patients
Exceptional Physicians Group Bullhead City Hospital PLLC CurrentSince Oct 24, 2024 Accepting new patients
Clin-Path Pathology Anatomic Pathology & Clinical Pathology CurrentSince Jul 18, 2011 Accepting new patients
Exceptional Health Care Prescott LLC PastSince Aug 1, 2024 Accepting new patients
Exceptional Health Care Bullhead City LLC PastSince Nov 19, 2023 Accepting new patients
Sonoran Radiology LTD Past Accepting new patients

Locations

2365 Highway 95
Bullhead City, AZ 86442
Phone (928) 224-2443

1955 W Frye Rd
Chandler, AZ 85224
Phone (480) 507-2961

19060 N John Wayne Pkwy
Maricopa, AZ 85139
Phone (480) 631-0675

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

4313 E Cotton Center Blvd
Ste 120
Phoenix, AZ 85040
Phone (480) 478-8000

424 S 56th St
Ste 120
Phoenix, AZ 85034
Phone (480) 478-8059

2000 W Bethany Home Rd
Phoenix, AZ 85015
Phone (480) 209-4000

424 S 56th St
Ste 110
Phoenix, AZ 85034
Phone (480) 478-8057

4822 E State Route 69
Prescott, AZ 86301
Phone (436) 341-7800

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

1255 W Washington St
Tempe, AZ 85288
Phone 602685521145166

2648 S Araby Rd
Yuma, AZ 85365
Phone 4693417800100

3514 Cedar Springs Rd
Dallas, TX 75219
Phone (281) 415-6687

Organizations & group practices 9

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 9

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": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596585600000",
    "number": "1447454046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 42210",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850802210",
            "telephone_number": "623-266-7770",
            "fax_number": "623-322-4639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 S 56TH ST STE 110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850342177",
            "telephone_number": "602-685-5211",
            "fax_number": "602-685-5325"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "424 S 56th St Ste 120",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850342177",
            "country_code": "US",
            "telephone_number": "602-685-5211",
            "fax_number": "602-685-5325",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1955 W Frye Rd",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852246282",
            "country_code": "US",
            "telephone_number": "602-685-5211",
            "fax_number": "602-685-5325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAHBAH",
        "first_name": "MARY",
        "middle_name": "MICHELE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-14",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AZ",
            "license": "44522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MYUTMB 2790078981-COMMERCIAL NUMBER",
            "identifier": "2790078981",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "619361",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.