Individual provider Active NPI

Paul SK Tamanaha, MD

  • Obstetrics & Gynecology Physician
  • Gilbert, AZ
National Provider Identifier
1649275645
Registry record updated Sep 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
22014 Issued in AZ
Practice address
2550 E Guadalupe Rd Ste 109
Gilbert, AZ 85234
Phone
(480) 505-4475
Fax
(480) 505-4252
NPI assigned
Jun 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 22014 AZ Primary

Addresses

Primary practice location

2550 E Guadalupe Rd Ste 109
Gilbert, AZ 85234

Mailing address

2545 W Frye Rd Ste 9
Chandler, AZ 85224-6273
Phone (480) 505-4258

Other identifiers 1

IdentifierTypeStateIssuer
315657MedicaidAZ

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
I20040511000135 AZ Practitioner - Obstetrics/Gynecology 6305835778 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Hawaii John a. Burns School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwest Contemporary Women'S Care PCGroup PAC ID 0648256156, 23 clinicians

Practice addresses (Care Compare)

16611 S 40TH St
Suite 180
Phoenix, AZ 85048-0566
Phone (480) 785-2100

2550 E Guadalupe Rd
Suite 109
Gilbert, AZ 85234-5114
Phone (480) 505-4475

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo Obstetrics & Gynecology PastSince Apr 29, 2015 Accepting new patients
Banner Desert Medical Center Past Accepting new patients

Organizations & group practices 3

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": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536105600000",
    "number": "1649275645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2545 W FRYE RD STE 9",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852246273",
            "telephone_number": "480-505-4258",
            "fax_number": "480-275-8346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 E GUADALUPE RD STE 109",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85234",
            "telephone_number": "480-505-4475",
            "fax_number": "480-505-4252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAMANAHA",
        "first_name": "PAUL",
        "middle_name": "SK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2018-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "AZ",
            "license": "22014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "315657",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

Verify at the official NPI Registry.