NPIMap

Organization Active NPI

Diabetes America Az LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Chandler, AZ
National Provider Identifier
1992966998
Registry record updated Aug 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
DIABETES AMERICA AZ LLC
Practice address
2875 W Ray Rd
Suite 16
Chandler, AZ 85224-3524
Phone
(480) 855-6075
Fax
(480) 855-6085
NPI assigned
Jun 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2011

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

Authorized official

Name
Tina Johnson
Title
Credentialing Coordinator
Phone
(713) 840-5245

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RE0101X Primary

Addresses

Primary practice location

2875 W Ray Rd
Suite 16
Chandler, AZ 85224-3524

Mailing address

13171 Misty Willow Dr
Houston, TX 77070-5635
Phone (832) 237-3500

Other identifiers 1

IdentifierTypeStateIssuer
407282MedicaidAZ

National Provider Directory

National Provider Directory

Locations

13171 Misty Willow Dr
Houston, TX 77070
Phone (866) 693-4223

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312761600000",
    "number": "1992966998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13171 MISTY WILLOW DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770705635",
            "telephone_number": "832-237-3500",
            "fax_number": "832-237-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 W RAY RD",
            "address_2": "SUITE 16",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852243524",
            "telephone_number": "480-855-6075",
            "fax_number": "480-855-6085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETES AMERICA AZ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-23",
        "last_updated": "2011-08-08",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "713-840-5245"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407282",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2011; 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.