NPIMap

Individual provider Active NPI

Manikandan Sugumaran, M.D.

  • Otolaryngology Physician
  • Phoenix, AZ
National Provider Identifier
1932356367
Registry record updated Mar 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
46359 Issued in AZ
Practice address
4530 E Shea Blvd Ste 180
Phoenix, AZ 85028-6042
Phone
(602) 264-4834
Fax
(602) 254-5178
NPI assigned
Aug 27, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 46359 AZ Primary

Addresses

Primary practice location

4530 E Shea Blvd Ste 180
Phoenix, AZ 85028-6042

Mailing address

4530 E Shea Blvd Ste 180
Phoenix, AZ 85028-6042
Phone (602) 264-4834

Other identifiers 1

IdentifierTypeStateIssuer
709451MedicaidAZ

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
I20121019000536 AZ Practitioner - Otolaryngology 1052561446 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Northeastern Ohio University College of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Honorhealth AmbulatoryGroup PAC ID 5991603110, 630 clinicians
Arizona Otolaryngology Consultants, PCGroup PAC ID 5294621868, 22 clinicians

Practice addresses (Care Compare)

10510 N 92ND St
Scottsdale, AZ 85258-4566

19636 N 27TH Ave
Suite 201
Phoenix, AZ 85027-4015
Phone (623) 516-4400

4530 E Shea Blvd
Suite 180
Phoenix, AZ 85028-6042
Phone (602) 264-4834

5750 W Thunderbird Rd
Suite A100
Glendale, AZ 85306-4661
Phone (602) 938-3205

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.77 of 100Reported as individual
Quality
69.54
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner - University Physician Specialists LLC CurrentSince Dec 11, 2017 Accepting new patients
Arizona Otolaryngology Consultants, PC CurrentSince Sep 1, 2012 Accepting new patients
Banner - University Physician Specialists LLC CurrentSince Dec 11, 2017 Accepting new patients

Locations

5750 W Thunderbird Rd
Ste A100
Glendale, AZ 85306
Phone (602) 938-3205

1441 N 12th St
Fl 2
Phoenix, AZ 85006
Phone (602) 521-5180

1441 N 12th St
Fl 3
Phoenix, AZ 85006
Phone (602) 521-5700

1300 N 12th St
Ste 508
Phoenix, AZ 85006
Phone (602) 839-3927

2222 E Highland Ave
Ste 204
Phoenix, AZ 85016
Phone (602) 264-4834

4530 E Shea Blvd
Ste 180
Phoenix, AZ 85028
Phone (602) 264-4834

1441 N 12th St
Fl 2AND3
Phoenix, AZ 85006

5015 S Arizona Mills Cir
Tempe, AZ 85282
Phone (480) 534-4121

Interoperability endpoints

  • Direct secure messaging: manikandan.sugumaran.1@24142.direct.athenahealth.com

Organizations & group practices 4

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.

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": "1219795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1932356367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 E SHEA BLVD STE 180",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850286042",
            "telephone_number": "602-264-4834",
            "fax_number": "602-257-8319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 E SHEA BLVD STE 180",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850286042",
            "telephone_number": "602-264-4834",
            "fax_number": "602-254-5178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUGUMARAN",
        "first_name": "MANIKANDAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-27",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "AZ",
            "license": "46359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "709451",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.