NPIMap

Organization Active NPI

District Medical Group, Inc

  • Surgery Physician
  • Phoenix, AZ
National Provider Identifier
1619200722
Registry record updated Oct 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
DISTRICT MEDICAL GROUP, INC
Practice address
2525 E Roosevelt St
Surgery Clinic
Phoenix, AZ 85008-4948
Phone
(602) 344-5146
NPI assigned
Sep 9, 2009
Organization subpart
Yes
Parent organization
DISTRICT MEDICAL GROUP, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2014

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

Authorized official

Name
Teresa Cordeiro
Title
Credentialing Director
Phone
(602) 470-5000

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary
Surgical Critical Care PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0102X
Surgery of the Hand (Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0105X
Pediatric Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0120X
Plastic and Reconstructive Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0122X
Trauma Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0127X
Surgical Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086X0206X
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X

Addresses

Primary practice location

2525 E Roosevelt St
Surgery Clinic
Phoenix, AZ 85008-4948

Mailing address

2929 E Thomas Rd
Phoenix, AZ 85016-8034
Phone (602) 470-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091125000583 AZ Part B Supplier - Clinic/Group Practice 7315086691 Receives reassigned benefits from 1,603 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phoenix, AZ; Prescott, AZ; Scottsdale, AZ; Show Low, AZ; Sierra Vista, AZ; Sun City, AZ; Sun City West, AZ; Tucson, AZ…

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

National Provider Directory

National Provider Directory
Tax ID family
District Medical Group Inc31 organizations share this tax ID, including this one
Part of
District Medical Group Inc

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

Practitioners & affiliated clinicians

Practitioners 71

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

View all 71

NPI Registry JSON

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

{
    "created_epoch": "1252454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412121600000",
    "number": "1619200722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 E THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850168034",
            "telephone_number": "602-470-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 E ROOSEVELT ST",
            "address_2": "SURGERY CLINIC",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850084948",
            "telephone_number": "602-344-5146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTRICT MEDICAL GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DISTRICT MEDICAL GROUP, INC",
        "enumeration_date": "2009-09-09",
        "last_updated": "2014-10-01",
        "status": "A",
        "authorized_official_last_name": "CORDEIRO",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "602-470-5000"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Critical Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgery of the Hand",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Pediatric Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Trauma Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; 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.