NPIMap

Organization Active NPI

The Little Clinic of Arizona LLC

  • Family Nurse Practitioner
  • Buckeye, AZ
National Provider Identifier
1023216249
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
OTC 4233 Issued in AZ
Legal business name
THE LITTLE CLINIC OF ARIZONA LLC
Practice address
1300 S Watson Rd
Buckeye, AZ 85326-6303
Phone
(623) 241-5322
Fax
(623) 241-5323
NPI assigned
Jul 10, 2007
Last updated
Oct 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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

Authorized official

Name
Mr. Thomas Shelly, MD
Title
VP & General Manager
Phone
(615) 425-4200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X OTC 4233 AZ
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X OTC 4233 AZ Primary

Addresses

Primary practice location

1300 S Watson Rd
Buckeye, AZ 85326-6303

Mailing address

PO Box 932958
Cleveland, OH 44193-0028
Phone (615) 425-4200

Other practice location 1

155 W Combs Rd
San Tan Valley, AZ 85140-9108
Phone (480) 474-6620

Other practice location 2

13730 W Camelback Rd
Litchfield Park, AZ 85340-3075
Phone (623) 334-7745

Other practice location 3

1311 E Bell Rd
Phoenix, AZ 85022-2724
Phone (602) 594-5040

Other practice location 4

1935 N Stapley Dr
Mesa, AZ 85203-2749
Phone (480) 339-6178

Other practice location 5

6611 W Bell Rd
Glendale, AZ 85308-3607
Phone (623) 334-2953

Other practice location 6

1575 N Dysart Rd
Avondale, AZ 85392-1204
Phone (623) 687-9883

Other practice location 7

2724 S Signal Butte Rd
Mesa, AZ 85209-2104
Phone (480) 481-7210

Other practice location 8

2727 W Bell Rd
Phoenix, AZ 85053-3059
Phone (602) 680-2386

Other practice location 9

3100 N Glassford Hill Rd
Prescott Valley, AZ 86314-2285
Phone (928) 777-7820

Other practice location 10

3255 S Rural Rd
Tempe, AZ 85282-3853
Phone (480) 304-5467

Other practice location 11

6470 S Higley Rd
Gilbert, AZ 85298-4341
Phone (480) 809-2409

Other practice location 12

9900 S Rural Rd
Tempe, AZ 85284-4116
Phone (480) 783-6257

Other identifiers 1

IdentifierTypeStateIssuer
758664MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070907000182 AZ Part B Supplier - Clinic/Group Practice 4981797982 Receives reassigned benefits from 125 practitioners
Practice locations: Mesa, AZ; Tempe, AZ; Surprise, AZ; San Tan Valley, AZ; Prescott Valley, AZ; Phoenix, AZ; Litchfield Park, AZ; Gilbert, AZ…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2083424Little Clinic of Arizona LLC, the9900 S Rural Rd, Tempe, AZ 85284Certificate of waiverSep 3, 2026
03D2097236Little Clinic of Arizona LLC, the155 West Combs Rd, San Tan Valley, AZ 85140Certificate of waiverJun 9, 2027
03D2097238Little Clinic of Arizona LLC, the3100 N Glassford Hill Rd, Prescott Valley, AZ 86314Certificate of waiverJun 9, 2027
03D2112571Little Clinic of Arizona LLC, the13730 W Camelback Rd, Litchfield Park, AZ 85340Certificate of waiverMay 2, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

11425 W Buckeye Rd
Avondale, AZ 85323
Phone (623) 241-5316

2727 W Bell Rd
Phoenix, AZ 85053
Phone (602) 680-2386

4204 W Cactus Rd
Phoenix, AZ 85029
Phone (602) 547-5919

3100 N Glassford Hill Rd
Prescott Valley, AZ 86314
Phone (928) 445-0607

155 W Combs Rd
San Tan Vly, AZ 85140
Phone (480) 474-6601

Practitioners & affiliated clinicians

Practitioners 125

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 125

NPI Registry JSON

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761091200000",
    "number": "1023216249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 932958",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930028",
            "telephone_number": "615-425-4200",
            "fax_number": "615-891-5244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 S WATSON RD",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853266303",
            "telephone_number": "623-241-5322",
            "fax_number": "623-241-5323"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 W Combs Rd",
            "address_purpose": "LOCATION",
            "city": "San Tan Valley",
            "state": "AZ",
            "postal_code": "851409108",
            "country_code": "US",
            "telephone_number": "480-474-6620",
            "fax_number": "480-474-6621",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13730 W Camelback Rd",
            "address_purpose": "LOCATION",
            "city": "Litchfield Park",
            "state": "AZ",
            "postal_code": "853403075",
            "country_code": "US",
            "telephone_number": "623-334-7745",
            "fax_number": "623-334-7746",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1311 E Bell Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850222724",
            "country_code": "US",
            "telephone_number": "602-594-5040",
            "fax_number": "602-594-5041",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1935 N Stapley Dr",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852032749",
            "country_code": "US",
            "telephone_number": "480-339-6178",
            "fax_number": "480-339-6179",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6611 W Bell Rd",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853083607",
            "country_code": "US",
            "telephone_number": "623-334-2953",
            "fax_number": "623-334-2959",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1575 N Dysart Rd",
            "address_purpose": "LOCATION",
            "city": "Avondale",
            "state": "AZ",
            "postal_code": "853921204",
            "country_code": "US",
            "telephone_number": "623-687-9883",
            "fax_number": "623-687-9884",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2724 S Signal Butte Rd",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852092104",
            "country_code": "US",
            "telephone_number": "480-481-7210",
            "fax_number": "480-481-7211",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2727 W Bell Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850533059",
            "country_code": "US",
            "telephone_number": "602-680-2386",
            "fax_number": "602-680-2387",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3100 N Glassford Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Prescott Valley",
            "state": "AZ",
            "postal_code": "863142285",
            "country_code": "US",
            "telephone_number": "928-777-7820",
            "fax_number": "928-777-7821",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3255 S Rural Rd",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852823853",
            "country_code": "US",
            "telephone_number": "480-304-5467",
            "fax_number": "480-304-5468",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6470 S Higley Rd",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852984341",
            "country_code": "US",
            "telephone_number": "480-809-2409",
            "fax_number": "480-809-2410",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9900 S Rural Rd",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852844116",
            "country_code": "US",
            "telephone_number": "480-783-6257",
            "fax_number": "480-783-6258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE LITTLE CLINIC OF ARIZONA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-10",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A",
        "authorized_official_last_name": "SHELLY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "VP & GENERAL MANAGER",
        "authorized_official_telephone_number": "615-425-4200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "OTC 4233",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "OTC 4233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "758664",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buckeye, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.