NPIMap

Organization Active NPI

Erik de Jonghe MD PC

  • Specialist
  • Tucson, AZ
National Provider Identifier
1710180401
Registry record updated Jul 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
31026 Issued in AZ
Legal business name
ERIK DE JONGHE MD PC
Practice address
1601 W St Marys Rd
Tucson, AZ 85745
Phone
(520) 872-7383
Fax
(520) 872-7969
NPI assigned
Jun 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2008

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

Authorized official

Name
Kirsten Frederiksen, MD
Title
Practice Administrator
Phone
(520) 615-0318

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X 31026 AZ Primary

Addresses

Primary practice location

1601 W St Marys Rd
Tucson, AZ 85745

Mailing address

2202 N Forbes Blvd
Tucson, AZ 85745-1412
Phone (520) 872-7383

Other identifiers 1

IdentifierTypeStateIssuer
805228MedicaidAZ

National Provider Directory

National Provider Directory

Locations

1714 W Anklam Rd
Ste 105
Tucson, AZ 85745
Phone (520) 882-8161

File 51153
Los Angeles, CA 90074

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216598400000",
    "number": "1710180401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 N FORBES BLVD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857451412",
            "telephone_number": "520-872-7383",
            "fax_number": "520-872-7969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 W ST MARYS RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85745",
            "telephone_number": "520-872-7383",
            "fax_number": "520-872-7969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIK DE JONGHE MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-08",
        "last_updated": "2008-07-21",
        "status": "A",
        "authorized_official_last_name": "FREDERIKSEN",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "520-615-0318",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "AZ",
            "license": "31026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805228",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.

Verify at the official NPI Registry.