Individual provider Active NPI

Luyi De Prada, MD

  • Nephrology Physician
  • Peoria, AZ
National Provider Identifier
1639480452
Registry record updated Aug 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
50752 Issued in AZ
Practice address
7362 W Thunderbird Rd
Peoria, AZ 85381-5028
Phone
(602) 843-5455
NPI assigned
Jun 25, 2010
Last updated
Aug 28, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MT197763 PA
Nephrology Physician 207RN0300X 50752 AZ Primary

Addresses

Primary practice location

7362 W Thunderbird Rd
Peoria, AZ 85381-5028

Mailing address

2149 East Warner Road Ste 102
Tempe, AZ 85284-3495
Phone (480) 610-6100

Other identifiers 1

IdentifierTypeStateIssuer
041439MedicaidAZ

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
I20150813012078 AZ Practitioner - Nephrology 8224343637 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Loma Linda University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southwest Kidney Institute PLCGroup PAC ID 8224930987, 100 clinicians

Practice addresses (Care Compare)

13943 N 91St Ave
Suite 101
Peoria, AZ 85381-3688
Phone (480) 610-6100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT197763PAMDInternal Medicine Physician
50752AZMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Kidney Institute Scottsdale LLC Nephrology CurrentSince Aug 20, 2015 Accepting new patients

Locations

337 E Coronado Rd
Ste 201
Phoenix, AZ 85004
Phone (602) 252-8081

2149 E Warner Rd
Ste 101
Tempe, AZ 85284
Phone (480) 610-6111

2149 E Warner Rd
Ste 102
Tempe, AZ 85284
Phone (623) 247-0808

Interoperability endpoints

  • Direct secure messaging: luyi.de.prada.1@2697.direct.athenahealth.com

Organizations & group practices 2

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440720000000",
    "number": "1639480452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2149 EAST WARNER ROAD STE 102",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852843495",
            "telephone_number": "480-610-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7362 W THUNDERBIRD RD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853815028",
            "telephone_number": "602-843-5455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE PRADA",
        "first_name": "LUYI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-25",
        "last_updated": "2015-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT197763",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AZ",
            "license": "50752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "041439",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

Verify at the official NPI Registry.