Active NPI
Anthony Michael Digeorge, M.D.
- Pediatrics Physician
- Mesa, AZ
National Provider Identifier
1689852105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 16947
- Practice address
- 1345 E Main St
103
Mesa, AZ 85203-8947 - Phone
- (480) 223-0290
- Fax
- (480) 223-0295
- NPI assigned
- Feb 6, 2008
- Last updated
- Feb 6, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 16947 | AZ | Primary |
| Pediatric Endocrinology Physician | 2080P0205X | 16947 | AZ |
Addresses
Primary practice location
1345 E Main St
103
Mesa, AZ 85203-8947
Mailing address
1345 E Main St
103
Mesa, AZ 85203-8947
Phone (480) 223-0290
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 331877 | Other | AZ | AHCCCS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16947 | AZ | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Canyon Pediatrics, Inc | Pediatrics | Past | Accepting new patients |
| Sultan Y Ayoub FNP PLLC | Past | Accepting new patients | |
| Canyon Pediatrics, Inc | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GBGIBD
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pediatrics Physician
- Gilbert, AZ
- NPI 1053176677
-
- Family Nurse Practitioner
- Gilbert, AZ
- NPI 1306288766
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202256000000",
"number": "1689852105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1345 E MAIN ST",
"address_2": "103",
"city": "MESA",
"state": "AZ",
"postal_code": "852038947",
"telephone_number": "480-223-0290",
"fax_number": "480-223-0295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1345 E MAIN ST",
"address_2": "103",
"city": "MESA",
"state": "AZ",
"postal_code": "852038947",
"telephone_number": "480-223-0290",
"fax_number": "480-223-0295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIGEORGE",
"first_name": "ANTHONY",
"middle_name": "MICHAEL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-06",
"last_updated": "2008-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AZ",
"license": "16947",
"primary": true
},
{
"code": "2080P0205X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Endocrinology",
"state": "AZ",
"license": "16947",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS",
"identifier": "331877",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.