Desert Grove Family Medical – Family Medicine Physician, NPI 1093764938
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Desert Grove Family Medical
PO BOX 844776
DALLAS, TX 752844776
Phone: (480) 834-7546
Fax: (480) 834-8001
Type: Mailing
20928 E Heritage Loop Rd Ste 106
Queen Creek, AZ 851423900
Phone: (480) 834-7546
Fax: (480) 833-8313
Type: Location
10238 E Hampton Ave Ste 506
Mesa, AZ 852093321
Phone: (480) 834-7546
Fax: (480) 833-8313
Type: Location
10238 E Hampton Ave Ste 508
Mesa, AZ 852093321
Phone: (480) 834-7546
Type: Location
1492 S Mill Ave Ste 101
Tempe, AZ 852815660
Phone: (480) 834-7546
Fax: (480) 833-8313
Type: Location
5656 S Power Rd Ste 126
Gilbert, AZ 852958489
Phone: (480) 834-7546
Fax: (480) 833-8313
Type: Location
1855 N STAPLEY DR
MESA, AZ 852033002
Phone: (480) 834-7546
Fax: (480) 833-8313
Type: Location
East McKellips Road, Los Maderas, Mesa, Maricopa County, Arizona, 85213, United States
STE 101
MESA, AZ 852039645
Phone: (480) 834-7546
Fax: (480) 834-8001
Type: Location
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.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-05-26
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040526000631 | O | Clinic/Group Practice | AZ | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 75284)
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