Collin Udall, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

15439 Issued in AZ

Practice address

3048 E Baseline Rd
Ste 109
Mesa, AZ 85204-7287

Phone

(480) 632-1117

Fax

(480) 632-1118

NPI assigned

May 27, 2005

Last updated

Sep 13, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Arizona College of Medicine, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Summit Medical Group Arizona LLCGroup PAC ID 3173872835, 152 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner Home Care-Arizona Home health agency, Mesa, AZ, CCN 037015
• Banner Baywood Medical Center Hospital, Mesa, AZ, CCN 030088

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: collin.udall.1@19654.direct.athenahealth.com
• Direct secure messaging: cudall@hmg.gwaydirect.com
• FHIR API: https://api.platform.athenahealth.com/19654/brand/1/csg/1/fhir/r4
• FHIR API: https://api.platform.athenahealth.com/21654/brand/1/csg/1/fhir/r4
• FHIR API: https://api.platform.athenahealth.com/22064/brand/1/csg/1/fhir/r4

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.

• Summit Medical Group Arizona LLC

  • Family Medicine Physician
  • Glendale, AZ
  • NPI 1053810622
  Medicare reassignment Care Compare group NPD
• Allen Family Medicine PLLC

  • Family Medicine Physician
  • Mesa, AZ
  • NPI 1356614176
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Banner Baywood Medical Center

  • General Acute Care Hospital
  • Mesa, AZ
  • NPI 1194758284
  Care Compare affiliation
• Banner Home Care-Arizona

  • Home Health Agency
  • Sun City, AZ
  • NPI 1023051927
  Care Compare affiliation

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315872000000",
    "number": "1861495434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3048 E BASELINE RD",
            "address_2": "STE 109",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852047286",
            "telephone_number": "480-632-1117",
            "fax_number": "480-632-1118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3048 E BASELINE RD",
            "address_2": "STE 109",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852047287",
            "telephone_number": "480-632-1117",
            "fax_number": "480-632-1118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UDALL",
        "first_name": "COLLIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2011-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "15439",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "AZ0878720",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "1Z1014",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA INSURANCE",
            "identifier": "621104",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jorge E Uceda, MD
• Kaitlyn Anne Uchimura
• Julia Starr Uchytil
• Ucxtra Air, LLC (UCX MedFlight)
• Ucxtra Umbrella, LLC (Urgent Care Extra AZ)
• John Hunt Udall, M.D.
• Muhammad Azhar Uddin, MD
• Rachael Nichal Uffens, LISAC
• Isabelle Marie Ugarte, MS
• Obumneke Jessica Ugbor, PA-C

• Family Medicine Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2011; 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.

Verify at the official NPI Registry.