Individual provider Active NPI

Nicole Diane Burca Gin, NP

  • Acute Care Nurse Practitioner
  • Mesa, AZ
National Provider Identifier
1497369334
Registry record updated Nov 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
227588 Issued in AZ
Practice address
6111 E Arbor Ave
Mesa, AZ 85206-6059
Phone
(480) 981-1326
Fax
(480) 981-1445
NPI assigned
Sep 8, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2100X 227588 AZ Primary

Addresses

Primary practice location

6111 E Arbor Ave
Mesa, AZ 85206-6059

Mailing address

PO Box 6423
Chandler, AZ 85246-6423
Phone (480) 981-1326

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200914001273 AZ Practitioner - Nurse Practitioner 2365860913 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ironwood Physicians PCGroup PAC ID 3577454842, 115 clinicians

Practice addresses (Care Compare)

6111 E Arbor Ave
Mesa, AZ 85206-6059
Phone (480) 981-1326

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ironwood Physicians, PC Multi-Specialty CurrentSince Oct 12, 2020 Accepting new patients
Ironwood Physicians, PC Multi-Specialty CurrentSince Oct 12, 2020 Accepting new patients

Locations

1637 E Monument Plaza Cir
Ste 1
Casa Grande, AZ 85122
Phone (480) 241-0240

685 S Dobson Rd
Chandler, AZ 85224
Phone (480) 324-5220

695 S Dobson Rd
Chandler, AZ 85224
Phone (480) 821-2823

3686 S Rome St
Gilbert, AZ 85297
Phone (480) 792-6006

6111 E Arbor Ave
Mesa, AZ 85206
Phone (480) 981-1326

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.

Hospital & facility affiliations 2

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": "1599523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669593600000",
    "number": "1497369334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6423",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852466423",
            "telephone_number": "480-981-1326",
            "fax_number": "480-981-1445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6111 E ARBOR AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852066059",
            "telephone_number": "480-981-1326",
            "fax_number": "480-981-1445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIN",
        "first_name": "NICOLE DIANE",
        "middle_name": "BURCA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-08",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "227588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.