John S Condojani, D.O.
Individual provider Active NPI Family Medicine Physician · Whiteriver, AZ
NPI 1497761555 · NPPES record last updated Jan 22, 2009
Key facts
- NPI
- 1497761555
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 0-317 (ID)
- Practice address
- 200 W. Hospital Dr
Whiteriver, AZ 85941 - Phone
- (928) 338-4911
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Winslow Memorial Hospital Inc
Winslow Indian Health Care Center Inc
Practice addresses (Care Compare)
1501 N Williamson Ave
Winslow, AZ 86047-2735
Phone (928) 289-4691
500 Indiana Ave
Winslow, AZ 86047-2169
500 N Indiana Ave
Winslow, AZ 86047-2169
Phone (928) 289-4646
SWC Navajo Route 15 and 60
1 Medical Center Dr
Dilkon, AZ 86047-2169
Phone (928) 289-4646
Hospital & facility affiliations
- Little Colorado Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050920001121 | TX | Practitioner - Family Practice | 2668463860 | Reassigns benefits to 1 organization |
| I20150716001976 | AZ | Practitioner - Family Practice | 2668463860 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0-317 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Winslow Indian Health Care Center, Inc | Current |
Accepting new patients | |
| Winslow Indian Health Care Group | Current |
Accepting new patients | |
| Winslow Indian Health Care Center, Inc | Current | Accepting new patients | |
| Winslow Memorial Hospital Inc | Current |
Accepting new patients | |
| Dilkon Medical Center | Current | Accepting new patients |
Locations
500 Indiana Ave
Winslow, AZ 86047
1500 N Williamson Ave
Winslow, AZ 86047
Phone (928) 289-3396
1501 N Williamson Ave
Winslow, AZ 86047
Phone (928) 289-4691
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0-317 | ID | Yes |
Addresses
Primary practice location
200 W. Hospital Dr
Whiteriver, AZ 85941
Mailing address
PO Box 860
Whiteriver, AZ 85941-0860
Phone (928) 338-4911
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295993376 | Medicaid | AZ | |
| 1629236716 | Medicaid | AZ | |
| 1871523191 | Medicaid | AZ | |
| 1780614008 | Medicaid | AZ | |
| 958655 | Medicaid | AZ |
Other providers in Whiteriver, AZ
- Cynthia Chism
- Elizabeth Catherine Clark
- Eben Clattenburg
- Cynda Jo Clift
- Charles L Cole
- Patrick Eugene Conlisk
- Gayla Mae Cox
- Todd Craft Jr.
- Lisa Christine Dailey
- Mary Angela Dalmolin
All providers in Whiteriver, AZ · Family Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.