Springfield Medical LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

40162 Issued in AZ

Legal business name

SPRINGFIELD MEDICAL LLC

Doing business as

Springfield Pediatrics

Practice address

36351 N Gantzel Rd Ste 127
San Tan Valley, AZ 85140-7329

Phone

(602) 734-5509

Fax

(877) 281-3385

NPI assigned

Jan 4, 2011

Organization subpart

No

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

Authorized official

Name

Oladiji G Vaughan, MDNPI 1043498520

Title

Owner

Phone

(602) 734-5509

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Springfield Pediatrics Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 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 2

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.

• Oladiji Gbolahan Vaughan, MD

  • Pediatrics Physician
  • San Tan Valley, AZ
  • NPI 1043498520
  Medicare reassignment Authorized official
• Andrea Zander

  • Pediatric Nurse Practitioner
  • San Tan Valley, AZ
  • NPI 1144913963
  Medicare reassignment NPD

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

{
    "created_epoch": "1294099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690243200000",
    "number": "1093019150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36351 N GANTZEL RD STE 127",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851407329",
            "telephone_number": "602-734-5509",
            "fax_number": "877-281-3385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36351 N GANTZEL RD STE 127",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851407329",
            "telephone_number": "602-734-5509",
            "fax_number": "877-281-3385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGFIELD MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-04",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A",
        "authorized_official_last_name": "VAUGHAN",
        "authorized_official_first_name": "OLADIJI",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-734-5509",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "40162",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": "AZ",
            "license": "40162",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "358032",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "584197",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Springfield Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Springfield Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatrics Physician in San Tan Valley, AZ
• Providers in San Tan Valley, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; 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.