DISTRICT MEDICAL GROUP, INC (NPI# 1366081705) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366081705 |
| Entity Type | Organization |
| Organization Name | DISTRICT MEDICAL GROUP, INC |
| Practice Address |
3624 W Anthem Way Ste C116 Anthem AZ 85086-0457 |
| Mailing Address |
2929 E Thomas Rd Phoenix AZ 85016-8034 |
| Practice Telephone | 6234345748 |
| Practice Fax Number | 6235518882 |
| Mailing Telephone | 6024705000 |
| Mailing Fax Number | 6024705064 |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2020-01-02 |
| Authorized Official Name | TERESA CORDEIRO (DIRECTOR, CREDENTIALING) |
| Authorized Official Telephone | 6024705519 |
| Is Organization Subpart | Y |
| Parent Organization Name | DISTRICT MEDICAL GROUP, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 475747 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124667555 | District Medical Group, Inc | Family Medicine | 15182 N 75th Ave Ste 180, Peoria, AZ 85381-4722 | 2020-01-02 |
| 1831722768 | District Medical Group, Inc | Surgery | 14155 N 83rd Ave Ste A105, Peoria, AZ 85381-5640 | 2020-02-19 |
| 1144860016 | District Medical Group, Inc | Internal Medicine | 6315 E Main St, Mesa, AZ 85205-8953 | 2020-01-08 |
| 1063052934 | District Medical Group, Inc | Family Medicine | 1805 N Scottsdale Rd, Tempe, AZ 85281-1556 | 2020-01-08 |
| 1538708979 | District Medical Group, Inc | Family Medicine | 10144 W Lake Pleasant Pkwy Ste 1110, Peoria, AZ 85382-9716 | 2020-01-02 |
| 1548653934 | District Medical Group, Inc | Emergency Medicine | 2601 E Roosevelt St, Toxicology, Phoenix, AZ 85008-4973 | 2015-03-10 |
| 1144624339 | District Medical Group, Inc | Emergency Medicine | 2601 E Roosevelt St, Emergency Medicine, Phoenix, AZ 85008-4973 | 2014-10-16 |
| 1407106719 | District Medical Group, Inc | Clinic/Center | 3141 N 3rd Ave, Phoenix, AZ 85013-4345 | 2012-09-13 |
| 1538484993 | District Medical Group, Inc | Internal Medicine | 2601 E Roosevelt St, Rheumatology, Phoenix, AZ 85008-4973 | 2010-03-29 |
| 1528396108 | District Medical Group, Inc | Anesthesiology | 2601 E Roosevelt St, Phoenix, AZ 85008-4973 | 2009-11-19 |
| Street Address |
3624 W ANTHEM WAY STE C116 |
| City | ANTHEM |
| State | AZ |
| Zip Code | 85086-0457 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760097703 | Cindy Ryanto | Pharmacist | 39508 W Daisy Mountain Dr, Phoenix, AZ 85086 | 2020-09-15 |
| 1912559857 | Cathey Michelle Allen | Massage Therapist | 39006 N 11th Ave, Phoenix, AZ 85086 | 2019-07-11 |
| 1174000871 | Anthem Eye Group Pllc | Optometrist | 4205 W Anthem Way #101, Anthem, AZ 85086 | 2018-07-25 |
| 1366982449 | Angela Ann Childs | Registered Nurse | 42104 N Venture Dr Ste D118, Anthem, AZ 85086 | 2017-03-08 |
| 1144772054 | Joe Bezerra | Specialist | 39818 N Bell Meadow Trl, Phoenix, AZ 85086 | 2016-10-26 |
| 1669821252 | Arizona Procedural Center | Clinic/Center | 3655 West Anthem Way, Suite 109 Box 272, Athem, AZ 85086 | 2016-06-06 |
| 1124499280 | Shane Carr | Physical Therapist | 39716 N 7th St, Phoenix, AZ 85086 | 2015-10-15 |
| 1790174167 | Kelly Christine Collins | Dermatology | 42211 N 41st Dr. #a109, Phoenix, AZ 85086 | 2015-01-22 |
| 1174953913 | Sung Ae Lee | Radiology | 820 W. Ravina Lane, Anthem, AZ 85086 | 2013-11-14 |
| 1881034080 | Bryan Michael Hays | Dentist | 40411 N Capra Way, Anthem, AZ 85086 | 2013-07-02 |
| Find all providers in zip 85086 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558543678 | Linda Brown | Internal Medicine | 3655 W Anthem Way Ste A109, Anthem, AZ 85086-0430 | 2007-11-30 |
| 1700068855 | Nirmalji Odedra | Internal Medicine | 3655 W. Anthem Wy Ste A-109 Pmb313, Anthem, AZ 85086 | 2007-11-30 |
| 1548233141 | John Boccia | Internal Medicine | 40417 N Capra Way, Anthem, AZ 85086-1704 | 2006-02-13 |
| 1013466192 | Ternion Physician Group, Pllc | Internal Medicine | 42104 N Venture Dr, Suite D118, Anthem, AZ 85086-3823 | 2016-09-29 |
| 1609153733 | Nisarg Sheth | Internal Medicine | 3655 W Anthem Way, Suite A109 Pmb 313, Anthem, AZ 85086 | 2011-11-03 |
| 1215221940 | Dustin Ray Everett | Internal Medicine | 3655 W Anthem Way, Suite A109 Pmb 313, Anthem, AZ 85086-0430 | 2011-05-28 |
| 1720388127 | Glick Family Medicine LLC | Internal Medicine | 41810 N Venture Dr, Suite E-160, Anthem, AZ 85086-3169 | 2010-11-01 |
| 1396052254 | Sadaf Jamil | Internal Medicine | 3655 W Anthem Way, Suite A-109 Pmb 313, Anthem, AZ 85086-0430 | 2010-09-13 |
| 1386964674 | Ronald Allen Charles | Internal Medicine | 3655 W Anthem Way, A:109 Pmb 313, Anthem, AZ 85086-0430 | 2010-06-09 |
| 1194977405 | Nezar N Dahdal | Internal Medicine | 3655 W Anthem Way, A-109; Pmb313, Anthem, AZ 85086-0430 | 2008-10-17 |
| Find all providers in ANTHEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.