Individual provider Active NPI

David Civic, MD

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1457462202
Registry record updated Oct 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
42516 Issued in AZ
Practice address
4212 N 16TH St
Phoenix, AZ 85016-5319
Phone
(602) 263-1511
Fax
(602) 263-1619
NPI assigned
Aug 31, 2006
Last updated
Oct 16, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 16, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 42516 AZ Primary

Addresses

Primary practice location

4212 N 16TH St
Phoenix, AZ 85016-5319

Mailing address

PO Box 31001-0698
Pasadena, CA 91110-0698
Phone (602) 263-1511

Other identifiers 2

IdentifierTypeStateIssuer
711087MedicaidAZ
AZ727300OtherAZBLUE CROSS BLUE SHIELD

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
I20200518000851 AZ Practitioner - Family Practice 5092750281 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of Ny Upstate Medical University, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Circle the CityGroup PAC ID 3971824442, 63 clinicians

Practice addresses (Care Compare)

210 S 12TH Ave
Phoenix, AZ 85007-3101
Phone (602) 254-4282

220 S 12TH Ave
Phoenix, AZ 85007-3101
Phone (602) 258-8282

333 W Indian School Rd
Phoenix, AZ 85013-3205
Phone (602) 776-9000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42516AZMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Circle the City CurrentSince May 1, 2020 Accepting new patients
Circle the City Family Medicine Current Accepting new patients
Circle the City CurrentSince May 1, 2020 Accepting new patients
Mainegeneral Health Associates Family Medicine Past Accepting new patients
Town of Winthrop Past Accepting new patients
Circle the City Past Accepting new patients

Locations

1125 W Jackson St
Ste 448
Phoenix, AZ 85007

220 S 12th Ave
Phoenix, AZ 85007
Phone (602) 372-2100

230 S 12th Ave
Ste 830
Phoenix, AZ 85007

300 W Clarendon Ave
Ste 200
Phoenix, AZ 85013
Phone (602) 776-0776

333 W Indian School Rd
Phoenix, AZ 85013
Phone (602) 248-0368

3333 E Van Buren St
Phoenix, AZ 85008
Phone (602) 690-0598

3522 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 776-7676

Organizations & group practices 6

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413417600000",
    "number": "1457462202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-0698",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911100698",
            "telephone_number": "602-263-1511",
            "fax_number": "602-263-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 N 16TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165319",
            "telephone_number": "602-263-1511",
            "fax_number": "602-263-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIVIC",
        "first_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2014-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "42516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "711087",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "AZ727300",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.