Individual provider Active NPI

Michael John Demko, DO

  • Family Medicine Physician
  • Mesa, AZ
National Provider Identifier
1477561652
Registry record updated May 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2943 Issued in AZ
Practice address
5252 E Main St
Mesa, AZ 85205-8022
Phone
(480) 396-3222
Fax
(480) 396-2298
NPI assigned
Aug 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2013

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 2943 AZ Primary

Addresses

Primary practice location

5252 E Main St
Mesa, AZ 85205-8022

Mailing address

5252 E Main St
Mesa, AZ 85205-8022
Phone (480) 396-3222

Other identifiers 1

IdentifierTypeStateIssuer
348260MedicaidAZ

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
I20100208000560 AZ Practitioner - Family Practice 5395888713 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Medical Group Arizona LLCGroup PAC ID 3173872835, 152 clinicians

Practice addresses (Care Compare)

5620 W Thunderbird Rd
Suite F1
Glendale, AZ 85306-4652
Phone (888) 698-6727

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group Arizona LLC Family Medicine CurrentSince Jun 13, 2022 Accepting new patients

Locations

5620 W Thunderbird Rd
Ste F1
Glendale, AZ 85306
Phone (602) 938-6960

14541 W Indian School Rd
#600
Goodyear, AZ 85395
Phone (623) 535-5599

6002 E Main St
Mesa, AZ 85205
Phone (480) 467-9543

5252 E Main St
Mesa, AZ 85205
Phone (480) 396-3222

7233 E Baseline Rd
Ste 126
Mesa, AZ 85209
Phone (480) 699-2222

Interoperability endpoints

  • Direct secure messaging: michael.demko.1@19654.direct.athenahealth.com

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": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368576000000",
    "number": "1477561652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5252 E MAIN ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852058022",
            "telephone_number": "480-396-3222",
            "fax_number": "480-396-2298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5252 E MAIN ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852058022",
            "telephone_number": "480-396-3222",
            "fax_number": "480-396-2298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMKO",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2013-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "2943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "348260",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.