Active NPI
Kelly M Luba, DO
- Family Medicine Physician
- Phoenix, AZ
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 3853
- Practice address
- 20940 N Tatum Blvd Ste 300
Phoenix, AZ 85050-7273 - Phone
- (480) 607-0060
- Fax
- (480) 607-5809
- NPI assigned
- Jan 11, 2006
- Last updated
- Mar 12, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 3853 | AZ | Primary |
Addresses
Primary practice location
20940 N Tatum Blvd Ste 300
Phoenix, AZ 85050-7273
Mailing address
20940 N Tatum Blvd Ste 300
Phoenix, AZ 85050-7273
Phone (480) 607-0060
Other practice location 1
20940 N Tatum Blvd
Ste 390
Phoenix, AZ 85050-4265
Phone (480) 607-0060
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 790809 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Midwestern University, Chicago College of Osteopathic Med, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
20940 N Tatum Blvd
Suite 300
Phoenix, AZ 85050-7273
Phone (480) 607-0060
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tiffany Nelson MD PLC | Family Medicine | Current | Accepting new patients |
Locations
20940 N Tatum Blvd
Ste 300
Phoenix, AZ 85050
Phone (480) 607-0060
20940 N Tatum Blvd
Ste 390
Phoenix, AZ 85050
Phone (480) 407-0060
Interoperability endpoints
- https://api.platform.athenahealth.com/29438/brand/1/csg/1/fhir/r4
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- kelly.luba.1@29438.direct.athenahealth.com
- kelly.lubado.p1@direct.desertridgefp.nextgenshare.com
Organizations & group practices 1
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.
-
dba Desert Ridge Family Physicians
- Family Medicine Physician
- Phoenix, AZ
- NPI 1477524916
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Tempe, AZ
- NPI 1568433969
-
dba HonorHealth Scottsdale Thompson Peak Medical Center
- General Acute Care Hospital
- Scottsdale, AZ
- NPI 1417152745
-
dba HonorHealth John C. Lincoln Medical Center
- General Acute Care Hospital
- Phoenix, AZ
- NPI 1770690695
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520812800000",
"number": "1740269406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20940 N TATUM BLVD STE 300",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850507273",
"telephone_number": "480-607-0060",
"fax_number": "480-607-5809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20940 N TATUM BLVD STE 300",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850507273",
"telephone_number": "480-607-0060",
"fax_number": "480-607-5809"
}
],
"practiceLocations": [
{
"address_1": "20940 N Tatum Blvd",
"address_2": "Ste 390",
"address_purpose": "LOCATION",
"city": "Phoenix",
"state": "AZ",
"postal_code": "850504265",
"country_code": "US",
"telephone_number": "480-607-0060",
"fax_number": "480-607-5809",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LUBA",
"first_name": "KELLY",
"middle_name": "M",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-11",
"last_updated": "2018-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "3853",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "790809",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.