Individual provider Active NPI

Pete Michalak, DO

  • Emergency Medicine Physician
  • Globe, AZ
National Provider Identifier
1912115817
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
1505 Issued in AZ
Practice address
5880 S Hospital Dr
Globe, AZ 85501-9447
Phone
(928) 425-3261
Fax
(928) 425-3859
NPI assigned
May 21, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 1505 AZ Primary

Addresses

Primary practice location

5880 S Hospital Dr
Globe, AZ 85501-9447

Mailing address

5880 S Hospital Dr
Globe, AZ 85501-9447
Phone (928) 425-3261

Other identifiers 1

IdentifierTypeStateIssuer
247503MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20191206001783 TX Practitioner - Emergency MedicinePractitioner - Physical Medicine and Rehabilitation 7012064942 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
San Carlos Apache Healthcare Corporation CurrentSince Oct 24, 2019 Accepting new patients
San Carlos Apache Healthcare Corporation CurrentSince Oct 24, 2019 Accepting new patients

Locations

103 Medicine Way Rd
Peridot, AZ 85542
Phone (928) 475-1200

Organizations & group practices 2

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": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1912115817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5880 S HOSPITAL DR",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855019447",
            "telephone_number": "928-425-3261",
            "fax_number": "928-425-3859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5880 S HOSPITAL DR",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855019447",
            "telephone_number": "928-425-3261",
            "fax_number": "928-425-3859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHALAK",
        "first_name": "PETE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "1505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "247503",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Globe, AZ

Sources for this page

Verify at the official NPI Registry.