Individual provider Active NPI

Mahesh M Kotwal, MD

  • Neonatal-Perinatal Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1619907797
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
11968 Issued in AZ
Practice address
4722 N 24TH St
Suite 150
Phoenix, AZ 85016-4800
Phone
(602) 256-4628
Fax
(855) 851-4319
NPI assigned
Jul 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 11968 AZ
Neonatal-Perinatal Medicine Physician 2080N0001X 11968 AZ Primary

Addresses

Primary practice location

4722 N 24TH St
Suite 150
Phoenix, AZ 85016-4800

Mailing address

4722 N 24TH St
Suite 150
Phoenix, AZ 85016-4800
Phone (602) 256-4628

Other practice location 1

500 W Thomas Rd Ste 250
Phoenix, AZ 85013-4215
Phone (602) 406-3520

Other identifiers 1

IdentifierTypeStateIssuer
283872-05MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220825002734 AZ Practitioner - Pediatric Medicine 7618115171 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
District Medical Group, Inc CurrentSince Jul 1, 2022 Accepting new patients
District Medical Group, Inc CurrentSince Jul 1, 2022 Accepting new patients
St. Joseph'S Hospital and Medical Center CurrentSince Aug 30, 2020 Accepting new patients
District Medical Group, Inc Current Accepting new patients
Sjhmc Physician Services CurrentSince Apr 1, 2024 Accepting new patients
Obstetrix Medical Group of Phoenix PC Neonatal-Perinatal Medicine Past Accepting new patients
District Medical Group, Inc Family Medicine Past Accepting new patients
Dignity Health Past Accepting new patients
Maricopa County Special Health Care District Past Accepting new patients

Locations

1800 E Florence Blvd
Casa Grande, AZ 85122
Phone (520) 381-6285

1200 N Beaver St
Flagstaff, AZ 86001
Phone (928) 213-6235

3555 S Val Vista Dr
Gilbert, AZ 85297
Phone (480) 434-4356

5555 W Thunderbird Rd
Glendale, AZ 85306
Phone (602) 588-5555

13677 W McDowell Rd
Goodyear, AZ 85395
Phone (623) 536-4200

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

500 W Thomas Rd
Ste 680
Phoenix, AZ 85013
Phone (602) 406-6017

2601 E Roosevelt St
Ste 0D10
Phoenix, AZ 85008

500 W Thomas Rd
Ste 250
Phoenix, AZ 85013
Phone (602) 263-9345

1919 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 933-0777

2525 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 344-1015

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

5102 W Campbell Ave
Phoenix, AZ 85031
Phone (623) 848-5000

9201 W Thomas Rd
Phoenix, AZ 85037
Phone (623) 327-4000

350 W Thomas Rd
Phoenix, AZ 85013
Phone (480) 339-5001

2929 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 470-5043

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

File 56765
Los Angeles, CA 90074

Interoperability endpoints

  • Direct secure messaging: mkotwal5148@direct.valleywisehealth.org

Organizations & group practices 9

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

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1619907797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4722 N 24TH ST",
            "address_2": "SUITE 150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164800",
            "telephone_number": "602-256-4628",
            "fax_number": "602-957-9438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4722 N 24TH ST",
            "address_2": "SUITE 150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164800",
            "telephone_number": "602-256-4628",
            "fax_number": "855-851-4319"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 W Thomas Rd Ste 250",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850134215",
            "country_code": "US",
            "telephone_number": "602-406-3520",
            "fax_number": "602-406-6162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOTWAL",
        "first_name": "MAHESH",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "11968",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "AZ",
            "license": "11968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "283872-05",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.