Individual provider Active NPI

Despina Laloudakis, NP

  • Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1497727192
Registry record updated Jan 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN089214 Issued in AZ
Practice address
4530 E Muirwood Dr
Suite 105
Phoenix, AZ 85048-7639
Phone
(480) 961-2303
Fax
(480) 961-0419
NPI assigned
Feb 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN089214 AZ Primary

Addresses

Primary practice location

4530 E Muirwood Dr
Suite 105
Phoenix, AZ 85048-7639

Mailing address

4530 E Muirwood Dr
Suite 105
Phoenix, AZ 85048-7639
Phone (480) 961-2303

Other identifiers 2

IdentifierTypeStateIssuer
2Z1482OtherAZHEALTHNET
504086MedicaidAZ

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
I20040818001397 AZ Practitioner - Nurse Practitioner 8820061690 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Internists of Ahwatukee PCGroup PAC ID 1759272958, 9 clinicians

Practice addresses (Care Compare)

4530 E Muirwood Dr
Suite 105
Phoenix, AZ 85048-7693
Phone (480) 961-2303

Hospital & facility affiliations

  • Dignity Health at Home Home health agency, Chandler, AZ, CCN 037281
  • Chandler Regional Medical Center Hospital, Chandler, AZ, CCN 030036
  • Honor Health John C. Lincoln Medical Center Hospital, Phoenix, AZ, CCN 030014

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN089214AZMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Internists of Ahwatukee, P.C. CurrentSince Jun 1, 2004 Accepting new patients
Hospice of the Southwest, LLC PastSince Jan 15, 2013 Accepting new patients

Locations

4530 E Muirwood Dr
Ste 105
Phoenix, AZ 85048
Phone (480) 961-2303

4530 E Muirwood Dr
Ste 105C
Phoenix, AZ 85048

10450 E Riggs Rd
Ste 103
Sun Lakes, AZ 85248
Phone (480) 895-2047

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 3

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": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200614400000",
    "number": "1497727192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 E MUIRWOOD DR",
            "address_2": "SUITE 105",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850487639",
            "telephone_number": "480-961-2303",
            "fax_number": "480-961-0419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 E MUIRWOOD DR",
            "address_2": "SUITE 105",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850487639",
            "telephone_number": "480-961-2303",
            "fax_number": "480-961-0419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LALOUDAKIS",
        "first_name": "DESPINA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-06",
        "last_updated": "2008-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "RN089214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "2Z1482",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504086",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.