Individual provider Active NPI

Timothy Fitzgerald, DO

  • General Practice Physician
  • Marana, AZ
National Provider Identifier
1811964836
Registry record updated Aug 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
2471 Issued in AZ
Practice address
13395 N Marana Main St
Marana, AZ 85653-7008
Phone
(520) 682-4111
Fax
(520) 818-3630
NPI assigned
Mar 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0320000477 VT
General Practice Physician 208D00000X 2471 AZ Primary

Addresses

Primary practice location

13395 N Marana Main St
Marana, AZ 85653-7008

Mailing address

PO Box 188
Marana, AZ 85653-0188
Phone (520) 682-4111

Other identifiers 1

IdentifierTypeStateIssuer
285404MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0320000477VTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marana Health Center, Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: tfitzgerald18166@elrio.direct.ci.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471996800000",
    "number": "1811964836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "city": "MARANA",
            "state": "AZ",
            "postal_code": "856530188",
            "telephone_number": "520-682-4111",
            "fax_number": "520-818-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13395 N MARANA MAIN ST",
            "city": "MARANA",
            "state": "AZ",
            "postal_code": "856537008",
            "telephone_number": "520-682-4111",
            "fax_number": "520-818-3630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2016-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "0320000477",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AZ",
            "license": "2471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "285404",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marana, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; 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.