NPIMap

Individual provider Active NPI

Clyde C Mendonca, MD

  • Nephrology Physician
  • Tempe, AZ
National Provider Identifier
1710919246
Registry record updated Jun 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
40391 Issued in AZ
Practice address
2141 E Warner Rd
Suite 101
Tempe, AZ 85284-3493
Phone
(480) 969-8714
Fax
(480) 464-0189
NPI assigned
Jul 7, 2006
Last updated
Jun 19, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2012

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 229265 MA
Nephrology Physician 207RN0300X 40391 AZ Primary

Addresses

Primary practice location

2141 E Warner Rd
Suite 101
Tempe, AZ 85284-3493

Mailing address

2149 E Warner Rd
Suite 101
Tempe, AZ 85284-3494
Phone (480) 610-6100

Other identifiers 1

IdentifierTypeStateIssuer
347927MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080710000703 AZ Practitioner - NephrologyPractitioner - Internal Medicine 7911907563 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1998
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)

36889 N Tom Darlington Dr
Suite A4
Carefree, AZ 85377-4605
Phone (480) 610-6100

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Cancer Center Specialists LLC CurrentSince Jan 3, 2025 Accepting new patients
Banner Cancer Center Specialists LLC CurrentSince Jan 3, 2025 Accepting new patients
Southwest Kidney Institute Scottsdale LLC Nephrology CurrentSince Jan 12, 2014 Accepting new patients
Southwest Kidney Davita Dialysis Partners, LLC PastSince Jan 1, 2020 Accepting new patients
Aeger Inpatient Services Internal Medicine Past Accepting new patients

Locations

16838 E Palisades Blvd
Bldg C
Fountain Hills, AZ 85268
Phone (480) 816-3131

2946 E Banner Gateway Dr
Gilbert, AZ 85234
Phone (480) 256-5450

2946 E Banner Gateway Dr
Rm 2008
Gilbert, AZ 85234
Phone (480) 256-4523

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

9746 N 90th Pl
Ste 205
Scottsdale, AZ 85258
Phone (480) 610-6152

2141 E Warner Rd
Ste 101
Tempe, AZ 85284
Phone (480) 969-8714

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: clyde.mendonca.1@2697.direct.athenahealth.com
  • Direct secure messaging: gehcmendo@yourcarecommunity.org

Organizations & group practices 6

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 10

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340064000000",
    "number": "1710919246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2149 E WARNER RD",
            "address_2": "SUITE 101",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852843494",
            "telephone_number": "480-610-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2141 E WARNER RD",
            "address_2": "SUITE 101",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852843493",
            "telephone_number": "480-969-8714",
            "fax_number": "480-464-0189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDONCA",
        "first_name": "CLYDE",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2012-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "229265",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AZ",
            "license": "40391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "347927",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

Verify at the official NPI Registry.