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NPI 1013020460ActiveIndividual· Emergency Medicine· Fort Defiance, AZ

Emergency Medicine in Fort Defiance, Arizona, licensed in NM and CO, with an NPI issued in August 2006. Mostly services rather than prescriptions: Medicare paid $9,196 for 120 patients in 2024, with only 34 Part D claims.

Overview

NPI1013020460
StatusActive
Entity typeIndividual
Sole proprietorNo
NPI issuedAug 17, 2006
Last updated in NPPESAug 18, 2026
Certified by providerAug 18, 2026

Specialties and licenses

TaxonomyCodeLicenseState
Emergency Medicine Primary207P00000XMD2010-0108NM
Emergency Medicine207P00000X38249CO

About license numbers in NPPES

Exclusion screening

ListResultDetails
HHS-OIG LEIE · Oct 9, 2026No matchChecked by NPI and by name + state
North Carolina Medicaid · Nov 4, 2026No match—
New York OMIG · Nov 4, 2026No match—
Ohio Medicaid · Nov 4, 2026No match—
Pennsylvania Medicheck · Nov 4, 2026No match—
Washington HCA · Nov 4, 2026No match—

Official OIG search · How matching works ·Bulk check a roster

Medicare

Enrollment (PECOS)Enrolled Practitioner - Emergency Medicine (NM); Practitioner - Emergency Medicine (TX)
Accepts assignmentYes (participating)

Medicare services in 2024

Medicare patients120
Services billed135 across 4 procedure codes
Paid by Medicare$9,196

Part D prescriptions in 2024

Prescriptions (claims)34 · 34 30-day fills
Patients31
Total drug cost$996.51
Generic share91% of claims

Medicare sources and data years

Industry payments (Open Payments)

None reported for 2025 or 2024.

Receiving payments does not imply wrongdoing. What Open Payments covers ·original records

Other Emergency Medicine providers in Fort Defiance

All Emergency Medicine providers in Arizona →