Individual provider Active NPI

Megan Maureen Schicktanz, DO

  • Pediatrics Physician
  • Mesa, AZ
National Provider Identifier
1932737111
Registry record updated Jun 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
RS2022-0883 Issued in NM
Practice address
1400 S Dobson Rd
Mesa, AZ 85202-4707
Phone
(505) 272-5551
NPI assigned
Apr 1, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NM
Pediatrics Physician 208000000X RS2022-0883 NM Primary

Addresses

Primary practice location

1400 S Dobson Rd
Mesa, AZ 85202-4707

Mailing address

1400 S Dobson Rd
Mesa, AZ 85202-4707

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230908001560 AZ Practitioner - Pediatric Medicine 3476970997 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RS2022-0883NMMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Physician Super Specialists Arizona LLC Current Accepting new patients
Banner Physician Super Specialists Arizona LLC CurrentSince Oct 1, 2023 Accepting new patients
Banner Physician Super Specialists Arizona LLC CurrentSince Oct 1, 2023 Accepting new patients
Banner Desert Medical Center Past Accepting new patients

Locations

1432 S Dobson Rd
Ste 301
Mesa, AZ 85202
Phone (480) 412-7120

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

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.

NPI Registry JSON

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

{
    "created_epoch": "1585699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1932737111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S DOBSON RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S DOBSON RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024707",
            "telephone_number": "505-272-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHICKTANZ",
        "first_name": "MEGAN",
        "middle_name": "MAUREEN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-01",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NM",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "RS2022-0883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.