Phoenix Children'S Medical Group

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

SH3107 Issued in AZ

Legal business name

PHOENIX CHILDREN'S MEDICAL GROUP

Practice address

1665 N Avondale Blvd
Avondale, AZ 85392-5003

Phone

(602) 933-0005

Fax

(602) 933-2478

NPI assigned

Feb 14, 2013

Organization subpart

Yes

Parent organization

PHOENIX CHILDREN'S HOSPITAL, INC.As reported in NPPES

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

Authorized official

Name

Raheel Farough

Title

SVP, Managed Care & Payer Strategy

Phone

(602) 933-3548

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Phoenix Children's Ambulatory Specialty Center - Avondale Other name

Tax ID family

Phoenix Childrens Hospital3 organizations share this tax ID, including this one

Part of

Phoenix Children'S Hospital Inc

Other organizations with this tax ID 2

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

• Phoenix Children'S Hospital, Inc.

  • Pediatrics Physician
  • Scottsdale, AZ
  • NPI 1417121393
  NPD tax ID
• Phoenix Children'S Medical Group

  • Multi-Specialty Clinic/Center
  • Scottsdale, AZ
  • NPI 1316203383
  NPD tax ID

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

{
    "created_epoch": "1360800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1154660959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2108 E THOMAS RD STE 130",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850160008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 N AVONDALE BLVD",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853925003",
            "telephone_number": "602-933-0005",
            "fax_number": "602-933-2478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX CHILDREN'S MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOENIX CHILDREN'S HOSPITAL, INC.",
        "enumeration_date": "2013-02-14",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A",
        "authorized_official_last_name": "FAROUGH",
        "authorized_official_first_name": "RAHEEL",
        "authorized_official_title_or_position": "SVP, MANAGED CARE & PAYER STRATEGY",
        "authorized_official_telephone_number": "602-933-3548"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "AZ",
            "license": "SH3107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "876253",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Children's Ambulatory Specialty Center - Avondale",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Phoenix Children's Ambulatory Specialty Center - Avondale",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Brian Phan, RPH
• Thihan Phan, DDS
• Bronsun Bouyasith Phengdy, PTA
• Dametria Phillips
• Phoenix Children'S Hospital, Inc.
• Phoenix Diagnostic Imaging Inc
• Phoenix Family Psychiatry LLC
• Phoenix Residential Behavioral Health LLC
• Physiotherapy Associates, Inc.
• Mia Picciano, DPT

• Multi-Specialty Clinic/Center in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Multi-Specialty Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; 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.