Individual provider Active NPI

Nisha Patel, MD

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1487917308
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
58719 Issued in AZ
Practice address
20940 N Tatum Blvd Ste 300
Phoenix, AZ 85050-7273
Phone
(480) 607-0060
NPI assigned
Jun 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 58719 AZ Primary

Addresses

Primary practice location

20940 N Tatum Blvd Ste 300
Phoenix, AZ 85050-7273

Mailing address

3190 N Swan Rd
Tucson, AZ 85712-1227
Phone (520) 547-9700

Other identifiers 1

IdentifierTypeStateIssuer
45513OtherPAUSMLE

Other names 1

  • Nisha Mehta Former name

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
I20190802002454 AZ Practitioner - Family Practice 6800104167 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
58719AZMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona Community Physicians PC Family Medicine CurrentSince Aug 1, 2019 Accepting new patients
Arizona Community Physician PC CurrentSince Aug 1, 2019 Accepting new patients

Locations

3190 N Swan Rd
Tucson, AZ 85712
Phone (520) 547-9700

5055 E Broadway Blvd
Ste A100
Tucson, AZ 85711
Phone (520) 327-0460

2055 W Hospital Dr
Tucson, AZ 85704
Phone (520) 547-5725

Interoperability endpoints

  • Direct secure messaging: nisha.patel.p1@direct.desertridgefp.nextgenshare.com

Organizations & group practices 2

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": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1487917308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3190 N SWAN RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857121227",
            "telephone_number": "520-547-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20940 N TATUM BLVD STE 300",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850507273",
            "telephone_number": "480-607-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "NISHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "58719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "USMLE",
            "identifier": "45513",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NISHA",
            "last_name": "MEHTA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.