Individual provider Active NPI

Angela Broad White, MD

  • Emergency Medicine Physician
  • Tuba City, AZ
National Provider Identifier
1669905600
Registry record updated Feb 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A159782 Issued in CA
Practice address
167 N Main St
Tuba City, AZ 86045-0600
Phone
(928) 283-2501
NPI assigned
Apr 6, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X A159782 CA Primary

Addresses

Primary practice location

167 N Main St
Tuba City, AZ 86045-0600

Mailing address

1411 E 31St St
Qic 22123
Oakland, CA 94602-1018

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200820003240 CA Practitioner - Emergency Medicine 9537586367 Reassigns benefits to 1 organization
I20220201000172 TX Practitioner - Emergency Medicine 9537586367 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of California, San Francisco School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

167 N Main St
Tuba City Indian Medical Center
Tuba City, AZ 86045-0600
Phone (928) 283-2094

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.59 of 100Reported as group
Quality
47.51
Promoting interoperability
69
Improvement activities
40
Cost
86.96

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A159782CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tuba City Regional Health Care Corporation Family Medicine CurrentSince Oct 15, 2021 Accepting new patients
Tuba City Regional Health Care Corporation Emergency Medicine Current Accepting new patients
Tuba City Regional Health Care Corporation Family Medicine CurrentSince Oct 15, 2021 Accepting new patients
Team Physicians of California Medical Group Inc Emergency Medicine CurrentSince Jul 1, 2020 Accepting new patients

Locations

975 S Fairmont Ave
Lodi, CA 95240
Phone (209) 339-7575

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1491436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645142400000",
    "number": "1669905600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 E 31ST ST",
            "address_2": "QIC 22123",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946021018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 N MAIN ST",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "860450600",
            "telephone_number": "928-283-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "ANGELA",
        "middle_name": "BROAD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-06",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A159782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuba City, AZ

Sources for this page

Verify at the official NPI Registry.