NPIMap

Organization Active NPI

Old Pueblo Cardiology PC

  • Cardiovascular Disease Physician
  • Tucson, AZ
National Provider Identifier
1568643229
Registry record updated Jan 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
OLD PUEBLO CARDIOLOGY PC
Practice address
3955 E Fort Lowell Rd
Suite 113
Tucson, AZ 85712-1041
Phone
(520) 323-7277
Fax
(520) 881-1968
NPI assigned
Nov 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2012

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

Authorized official

Name
Lee GoldbergNPI 1609895218
Title
Medical Director
Phone
(520) 323-7277

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary
Radiology Clinic/Center 261QR0200X

Addresses

Primary practice location

3955 E Fort Lowell Rd
Suite 113
Tucson, AZ 85712-1041

Mailing address

PO Box 64086
Tucson, AZ 85728-4086
Phone (520) 323-7277

Other identifiers 1

IdentifierTypeStateIssuer
Z119329OtherAZPTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080114000407 AZ Part B Supplier - Clinic/Group Practice 2668553843 Receives reassigned benefits from 8 practitioners
Practice locations: Tucson, AZ

National Provider Directory

National Provider Directory

Locations

4640 E Sunrise Dr
Ste 217
Tucson, AZ 85718
Phone (520) 323-7277

5170 E Glenn St
Ste 160
Tucson, AZ 85712
Phone (520) 298-7900

900 W Scott St
Willcox, AZ 85643
Phone (520) 384-4421

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327017600000",
    "number": "1568643229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64086",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857284086",
            "telephone_number": "520-323-7277",
            "fax_number": "520-881-1968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3955 E FORT LOWELL RD",
            "address_2": "SUITE 113",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857121041",
            "telephone_number": "520-323-7277",
            "fax_number": "520-881-1968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD PUEBLO CARDIOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-21",
        "last_updated": "2012-01-20",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "520-323-7277"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "Z119329",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.