Maristela Y Nabong-Nillas, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

30745 Issued in SC

Practice address

1705 W Main St
Mesa, AZ 85201-6920

Phone

(623) 583-3001

NPI assigned

Nov 1, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: maristela.nabong-nillas@lrmc.directbygreenway.com

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.

• Adelante Healthcare, Inc.

  • Federally Qualified Health Center (FQHC)
  • Wickenburg, AZ
  • NPI 1083772545
  Medicare reassignment NPD
• Adelante Healthcare, Inc

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1144419284
  NPD
• Adelante Healthcare, Inc

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1215734124
  NPD
• Adelante Healthcare, Inc.

  • Federally Qualified Health Center (FQHC)
  • Surprise, AZ
  • NPI 1205994761

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1629155338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3033 N CENTRAL AVE STE 145",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122808",
            "telephone_number": "623-583-3001",
            "fax_number": "623-583-3007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 W MAIN ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852016920",
            "telephone_number": "623-583-3001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NABONG-NILLAS",
        "first_name": "MARISTELA",
        "middle_name": "Y",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "30745",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6961002",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "082796",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "307457",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Narendra Prasad Myneni, M.D
• Craig A. Myrmel, D.D.S.
• Amelia Jean Myroniak
• N-Emotion LLC
• Tony Naber, PT
• Thomas A Nack Jr., DMD
• Emily Naclerio, MD
• Naffa LLC
• Naffa Wellness LLC
• Soumya Nagaraja, MD

• Pediatrics Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.