NPIMap

Individual provider Active NPI

Monica R Vandivort, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Sierra Vista, AZ
National Provider Identifier
1720044365
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
26972 Issued in AZ
Practice address
599 E Wilcox Dr
Sierra Vista, AZ 85635-2531
Phone
(520) 459-4604
Fax
(520) 458-2444
NPI assigned
Apr 22, 2006
Last updated
Apr 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 26972 AZ Primary

Addresses

Primary practice location

599 E Wilcox Dr
Sierra Vista, AZ 85635-2531

Mailing address

599 E Wilcox Dr
Sierra Vista, AZ 85635-2531
Phone (520) 459-4604

Other identifiers 1

IdentifierTypeStateIssuer
445230MedicaidAZ

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
I20100729000917 AZ Practitioner - Geriatric MedicinePractitioner - Internal Medicine 3577548221 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Internal Medicine
Education
University of Kansas School of Med (KC/Wich/Sal), 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
LCS Healthcare Group LLCGroup PAC ID 8820391436, 4 clinicians

Practice addresses (Care Compare)

599 E Wilcox Dr
Sierra Vista, AZ 85635-2531
Phone (520) 459-4604

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.34 of 100Reported as apm
Quality
74.56
Promoting interoperability
99
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue54
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
LCS Healthcare Group LLC CurrentSince Apr 13, 2024 Accepting new patients
Quiburi Mission Nursing & Rehabilitation LLC Past Accepting new patients
The Evangelical Lutheran Good Samaritan Society Past Accepting new patients
Haven of Sierra Vista, LLC Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

599 E Wilcox Dr
Sierra Vista, AZ 85635
Phone (520) 459-4600

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12563/brand/1/csg/1/fhir/r4
  • Direct secure messaging: monica.vandivort.1@12563.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Haven Health Group LLCSierra Vista, AZ, CCN 035086 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 2023
Jun 1, 2023
Quiburi Mission Nursing & RehabilitationBenson, AZ, CCN 035214 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 18, 2024
Nov 18, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 7

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": "1145664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1720044365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "599 E WILCOX DR",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352531",
            "telephone_number": "520-459-4604",
            "fax_number": "520-459-4603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "599 E WILCOX DR",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352531",
            "telephone_number": "520-459-4604",
            "fax_number": "520-458-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDIVORT",
        "first_name": "MONICA",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-22",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "AZ",
            "license": "26972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "445230",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sierra Vista, AZ

Sources for this page

Verify at the official NPI Registry.