NPIMap

Individual provider Active NPI

Teresa J Tibbetts, MD

  • Family Medicine Physician
  • Lake Havasu City, AZ
National Provider Identifier
1750486445
Registry record updated Feb 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
27163 Issued in AZ
Practice address
2082 Mesquite Ave
Suite 106
Lake Havasu City, AZ 86403-6710
Phone
(928) 680-4233
Fax
(928) 680-6522
NPI assigned
Sep 14, 2006
Last updated
Feb 9, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 27163 AZ Primary

Addresses

Primary practice location

2082 Mesquite Ave
Suite 106
Lake Havasu City, AZ 86403-6710

Mailing address

PO Box 2325
Lake Havasu City, AZ 86405-2325
Phone (928) 680-4233

Other identifiers 6

IdentifierTypeStateIssuer
DD0854OtherAZRAILROAD MEDICARE GROUP #
474429MedicaidAZ
AZ0769200OtherAZBLUE CROSS BLUE SHIELD #
Z102474OtherAZMEDICARE INDIVIDUAL PTAN
2Z2286OtherAZHEALTH NET PROVIDER #
Z102475OtherAZMEDICARE GROUP PTAN

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
I20040501000473 AZ Practitioner - Family Practice 7517955313 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Creighton University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2082 Mesquite Ave
Suite 106a
Lake Havasu City, AZ 86403-6710
Phone (928) 680-4233

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Teresa J Tibbetts M D LLC Family Medicine CurrentSince Apr 1, 2005 Accepting new patients
Cornerstone Family Healthcare Family Medicine CurrentSince Mar 1, 2004 Accepting new patients
FPS Medical Center LTD Family Medicine Past Accepting new patients

Locations

2082 Mesquite Ave
Ste 106
Lk Havasu Cty, AZ 86403

2082 Mesquite Ave
Ste 106A
Lk Havasu Cty, AZ 86403

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/26249/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/IIFCBA
  • Direct secure messaging: teresa.tibbetts@cfh.eclinicaldirectplus.com

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.

Hospital & facility affiliations 8

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454976000000",
    "number": "1750486445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2325",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864052325",
            "telephone_number": "928-680-4233",
            "fax_number": "928-680-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2082 MESQUITE AVE",
            "address_2": "SUITE 106",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036710",
            "telephone_number": "928-680-4233",
            "fax_number": "928-680-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBBETTS",
        "first_name": "TERESA",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2016-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "27163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "DD0854",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "474429",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD #",
            "identifier": "AZ0769200",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PTAN",
            "identifier": "Z102474",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET PROVIDER #",
            "identifier": "2Z2286",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "Z102475",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

Verify at the official NPI Registry.