NPIMap

Organization Active NPI

Canyon Pediatrics, Inc

  • Pediatrics Physician
  • Gilbert, AZ
National Provider Identifier
1053176677
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CANYON PEDIATRICS, INC
Practice address
2451 E Baseline Rd Ste 200
Gilbert, AZ 85234-2405
Phone
(480) 776-7155
NPI assigned
Feb 14, 2024
Last updated
Mar 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

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

Authorized official

Name
Richard Brubaker, LMSWNPI 1285036798
Title
Ceo
Phone
(480) 507-2199

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

2451 E Baseline Rd Ste 200
Gilbert, AZ 85234-2405

Mailing address

2451 E Baseline Rd Ste 130
Gilbert, AZ 85234-2487
Phone (480) 776-7155

Other identifiers 1

IdentifierTypeStateIssuer
053504MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
Canyon Pediatrics4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GBGIBD

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1707868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742169600000",
    "number": "1053176677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2451 E BASELINE RD STE 130",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342487",
            "telephone_number": "480-776-7155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2451 E BASELINE RD STE 200",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342405",
            "telephone_number": "480-776-7155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON PEDIATRICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-14",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A",
        "authorized_official_last_name": "BRUBAKER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-507-2199",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053504",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.