NPIMap

Organization Active NPI

Midwest Internal Medicine PLLC

  • Internal Medicine Physician
  • Lake Havasu City, AZ
National Provider Identifier
1619019049
Registry record updated Mar 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MIDWEST INTERNAL MEDICINE PLLC
Practice address
1840 Mesquite Ave Ste B
Lake Havasu City, AZ 86403-5771
Phone
(928) 453-8500
Fax
(928) 453-3660
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2025

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

Authorized official

Name
Katrina A Ong-Veloso
Title
Administrator
Phone
(928) 453-9593

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

1840 Mesquite Ave Ste B
Lake Havasu City, AZ 86403-5771

Mailing address

1840 Mesquite Ave Ste B
Lake Havasu City, AZ 86403-5771
Phone (928) 453-8500

Other names 1

  • none Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040623001525 AZ Part B Supplier - Clinic/Group Practice 7618952425 Receives reassigned benefits from 5 practitioners
Practice locations: Lake Havasu City, AZ

National Provider Directory

National Provider Directory

Locations

45 Capri Blvd
Lk Havasu Cty, AZ 86403
Phone (928) 505-1030

3576 Kearsage Dr
Lk Havasu Cty, AZ 86406
Phone (928) 453-1500

147 W Riverside Dr
Parker, AZ 85344
Phone (928) 453-8500

Practitioners & affiliated clinicians

Practitioners 6

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": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741305600000",
    "number": "1619019049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 MESQUITE AVE STE B",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035771",
            "telephone_number": "928-453-8500",
            "fax_number": "928-453-3660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 MESQUITE AVE STE B",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035771",
            "telephone_number": "928-453-8500",
            "fax_number": "928-453-3660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST INTERNAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A",
        "authorized_official_last_name": "ONG-VELOSO",
        "authorized_official_first_name": "KATRINA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "928-453-9593"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "none",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2025; 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.