Unknown Individual – Rheumatology Physician, NPI 1124036371

Rheumatology Physician

Unknown Individual is a healthcare provider. based in Tucson, Arizona. specializing in Rheumatology Physician. They hold a License No. 35889 (AZ). The NPI Number for Unknown Individual is 1124036371

Main info

Organization

Inactive

26 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1124036371

Phone

(520) 202-3398

Address

1200 N EL DORADO PL STE I-910

Deactivation Date

15 September 2022

Doctor Profile

Medical School Name

OTHER

Secondary Phone

5205475725

Graduation Year

2000 (26 years ago)

PAC ID

3678578150

Group Practice PAC ID

4587560552

Professional Enrollment ID

I20060918000120

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

1200 N EL DORADO PL STE I-910
TUCSON, AZ 857154637
Phone: (520) 202-3398
Fax: (520) 202-3399
Type: Location
Passport Health Central Tucson Travel Clinic, 5055, East Broadway Boulevard, Poet's Square, Tucson, Pima County, Arizona, 85711, United States
SUITE A100
TUCSON, AZ 85711
Phone: (520) 382-1205
Fax: (520) 795-0225
Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 85715)

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Provider's Procedures

Unknown Individual performs procedures in Rheumatology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
RHEUMATOLOGY	AZ	73630	X-ray of foot, minimum of 3 views	59	30
RHEUMATOLOGY	AZ	83036	Hemoglobin A1C level	12	12

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 4587560552View full group profile

Name	Specialty	State
DR. DUNG T NGUYEN (DO)	Internal Medicine	AZ
AMY FITZGERALD (NP)	Nurse Practitioner	AZ
LENKA RYCHETSKY (M.D.)	Internal Medicine	AZ
DR. JOHN GREGORY CORCORAN (MD)	-	AZ
DR. JONATHAN R INSEL (MD)	-	AZ
MS. RENEE MARIE I HULTZ (FNP)	Nurse Practitioner	AZ
JAIME M LEDESMA (MD)	O B S T E T R I C S/ G Y N E C O L O G Y	AZ
STEWART LEWIS (FNP)	-	AZ
RACHEL S STOVER (MD)	Family Practice	AZ
DR. STEPHANIE W BELOKIN (D.O.)	Family Practice	AZ