Bethesda Pediatrics of Queen Creek

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

BETHESDA PEDIATRICS OF QUEEN CREEK

Doing business as

Main Street Pediatrics
Pediatrics of Queen Creek

Practice address

130 S 63Rd St
Mesa, AZ 85206-1620

Phone

(480) 792-9200

NPI assigned

Jan 14, 2021

Last updated

Jan 20, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stacie Self

Title

Billing

Phone

(480) 792-9200

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Main Street Pediatrics Doing business as
• PEDIATRICS OF QUEEN CREEK Doing business as

Electronic endpoints 1

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

CLIA laboratory certificates

Locations

Practitioners 5

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.

• Alyssa Marie Beck, FNP-C

  • Family Medicine Physician
  • Queen Creek, AZ
  • NPI 1861231268
  NPD (past)
• Luis Javier Bravo Pagan, MD

  • Pediatrics Physician
  • Queen Creek, AZ
  • NPI 1073163366
  NPD (past)
• Emilia Elizabeth Gomez Vieytez, MD

  • Pediatrics Physician
  • Queen Creek, AZ
  • NPI 1790969426
  NPD (past)
• Jere K O'Brien-Kinne, ARNP

  • Pediatric Nurse Practitioner
  • Gilbert, AZ
  • NPI 1194905885
  NPD (past)
• Jill Whelan, APN

  • Pediatric Nurse Practitioner
  • Addison, IL
  • NPI 1942344114
  NPD (past)

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

{
    "created_epoch": "1610582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1073102976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22707 S ELLSWORTH RD STE H101",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851427568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 S 63RD ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061620",
            "telephone_number": "480-792-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHESDA PEDIATRICS OF QUEEN CREEK",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-14",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A",
        "authorized_official_last_name": "SELF",
        "authorized_official_first_name": "STACIE",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "480-792-9200"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "538751",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "pediatricofqc.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "website",
            "address_1": "130 S 63rd St",
            "city": "Mesa",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852061620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Main Street Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PEDIATRICS OF QUEEN CREEK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatrics Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.