NPIMap

Organization Active NPI

District Medical Group, Inc

  • Surgery Physician
  • Peoria, AZ
National Provider Identifier
1831722768
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
DISTRICT MEDICAL GROUP, INC
Practice address
14155 N 83Rd Ave Ste A105
Peoria, AZ 85381-5640
Phone
(623) 486-7700
Fax
(623) 486-7703
NPI assigned
Feb 19, 2020
Last updated
Feb 19, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
DISTRICT MEDICAL GROUP, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Authorized official

Name
Teresa Cordeiro
Title
Director, Credentialing
Phone
(602) 470-5519

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

14155 N 83Rd Ave Ste A105
Peoria, AZ 85381-5640

Mailing address

2929 E Thomas Rd
Phoenix, AZ 85016-8034
Phone (602) 470-5000

Other identifiers 1

IdentifierTypeStateIssuer
475747MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
District Medical Group Inc31 organizations share this tax ID, including this one
Part of
District Medical Group Inc

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1831722768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 E THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850168034",
            "telephone_number": "602-470-5000",
            "fax_number": "602-470-5064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14155 N 83RD AVE STE A105",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853815640",
            "telephone_number": "623-486-7700",
            "fax_number": "623-486-7703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTRICT MEDICAL GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DISTRICT MEDICAL GROUP, INC",
        "enumeration_date": "2020-02-19",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "CORDEIRO",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "DIRECTOR, CREDENTIALING",
        "authorized_official_telephone_number": "602-470-5519"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "475747",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.