NPIMap

Organization Active NPI

TLC Pediatrics PLLC

  • Specialist
  • Phoenix, AZ
National Provider Identifier
1154530111
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
TLC PEDIATRICS PLLC
Practice address
16611 S 40TH St
Suite# 160
Phoenix, AZ 85048-0562
Phone
(480) 940-8527
Fax
(480) 940-8530
NPI assigned
May 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Diane K Matsumoto, MDNPI 1215039227
Title
Owner
Phone
(480) 940-8527

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X AZ Primary

Addresses

Primary practice location

16611 S 40TH St
Suite# 160
Phoenix, AZ 85048-0562

Mailing address

16611 S 40TH St
Suite# 160
Phoenix, AZ 85048-0562
Phone (480) 940-8527

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
03D1022312TLC Pediatrics PLLC16611 S 40TH Street, Suite 160, Phoenix, AZ 85048Certificate of waiverFeb 10, 2028

National Provider Directory

National Provider Directory

Locations

1783 E Queen Creek Rd
Ste 4
Chandler, AZ 85286

16611 S 40th St
Ste 160
Phoenix, AZ 85048
Phone (480) 940-8527

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1154530111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16611 S 40TH ST",
            "address_2": "SUITE# 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850480562",
            "telephone_number": "480-940-8527",
            "fax_number": "480-940-8530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16611 S 40TH ST",
            "address_2": "SUITE# 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850480562",
            "telephone_number": "480-940-8527",
            "fax_number": "480-940-8530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLC PEDIATRICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MATSUMOTO",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-940-8527",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.