NPIMap

Individual provider Active NPI

Peggy M Avina, MD

  • Family Medicine Physician
  • Elfrida, AZ
National Provider Identifier
1558362145
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25622 Issued in AZ
Practice address
10566 N Hwy 191
Elfrida, AZ 85610-9021
Phone
(520) 364-1429
Fax
(520) 364-4261
NPI assigned
Aug 3, 2005
Last updated
Aug 12, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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 25622 AZ Primary

Addresses

Primary practice location

10566 N Hwy 191
Elfrida, AZ 85610-9021

Mailing address

1205 F. Avenue
Douglas, AZ 85607
Phone (520) 364-1429

Other identifiers 1

IdentifierTypeStateIssuer
392001MedicaidAZ

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address PEGGYAVINA@cqch.cernerdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100504000612 AZ Practitioner - Family Practice 8022146554 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arizona College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bisbee Hospital AssociationGroup PAC ID 5092626168, 69 clinicians

Practice addresses (Care Compare)

101 Cole Ave
Bisbee, AZ 85603-1327
Phone (520) 432-5383

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25622AZMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bisbee Hospital Association CurrentSince Mar 29, 2010 Accepting new patients
Bisbee Hospital Association CurrentSince Mar 29, 2010 Accepting new patients
Bisbee Hospital Association Past Accepting new patients

Locations

101 Cole Ave
Bisbee, AZ 85603
Phone (520) 432-5383

7 Bisbee Rd
Bisbee, AZ 85603
Phone (520) 423-2042

100 E 5th St
Douglas, AZ 85607
Phone (520) 364-7659

10524 E Highway 92
Hereford, AZ 85615
Phone (520) 366-0300

Interoperability endpoints

  • Direct secure messaging: peggyavina@cqch.cernerdirect.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1558362145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 F. AVENUE",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "85607",
            "telephone_number": "520-364-1429",
            "fax_number": "520-364-4261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10566 N HWY 191",
            "city": "ELFRIDA",
            "state": "AZ",
            "postal_code": "856109021",
            "telephone_number": "520-364-1429",
            "fax_number": "520-364-4261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVINA",
        "first_name": "PEGGY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-03",
        "last_updated": "2022-08-12",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "25622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "392001",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "PEGGYAVINA@cqch.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Copper Queen Hospital Bisbee RHC Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "7 Bisbee Rd",
            "city": "Bisbee",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "856031140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elfrida, AZ

Sources for this page

Verify at the official NPI Registry.