Individual provider Active NPI

Michelina De la Maza Grimes, MD

  • Pediatrics Physician
  • Tucson, AZ
National Provider Identifier
1255779385
Registry record updated Feb 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
52125 Issued in AZ
Practice address
1625 N Campbell Ave
Tucson, AZ 85719
Phone
(520) 626-7053
Fax
(520) 626-6986
NPI assigned
Jun 11, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Hematology & Oncology Physician 2080P0207X 52155 AZ
Pediatrics Physician 208000000X 52125 AZ Primary

Addresses

Primary practice location

1625 N Campbell Ave
Tucson, AZ 85719

Mailing address

1625 N Campbell Ave
Tucson, AZ 85719-4330
Phone (520) 626-7053

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170830001672 AZ Practitioner - Pediatric Medicine 7012280852 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.34 of 100Reported as apm
Quality
74.56
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
52125AZMDPediatrics Physician
52155AZMDPediatric Hematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner - University Super Specialists LLC CurrentSince Jan 1, 2020 Accepting new patients
Banner-University Medical Group CurrentSince Jul 1, 2019 Accepting new patients
Children'S Clinics for Rehabilitative Services CurrentSince Jan 19, 2023 Accepting new patients
Phoenix Children'S Medical Group CurrentSince Aug 25, 2017 Accepting new patients
Banner Physician Super Specialists Arizona LLC CurrentSince Jul 1, 2019 Accepting new patients
Banner Physician Super Specialists Arizona LLC CurrentSince Jul 1, 2019 Accepting new patients
Phoenix Children'S Medical Group CurrentSince Aug 25, 2017 Accepting new patients
Phoenix Children'S Hospital Pediatrics Current Accepting new patients
Banner-University Medical Group Family Medicine CurrentSince Jul 1, 2019 Accepting new patients
Banner - University Medical Center Tucson Campus LLC Past Accepting new patients

Locations

1665 N Avondale Blvd
Avondale, AZ 85392
Phone (602) 933-0005

5757 W Thunderbird Rd
Ste E250
Glendale, AZ 85306
Phone (602) 865-4470

1432 S Dobson Rd
Ste 301
Mesa, AZ 85202
Phone (480) 412-7120

1432 S Dobson Rd
Ste 107
Mesa, AZ 85202
Phone (480) 412-4100

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

5131 E Southern Ave
Mesa, AZ 85206
Phone (480) 833-5437

755 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 271-5111

1919 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 933-0777

1625 N Campbell Ave
Tucson, AZ 85719

2600 N Wyatt Dr
Tucson, AZ 85712
Phone (520) 324-3600

2800 E Ajo Way
Tucson, AZ 85713
Phone (520) 294-4471

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771977600000",
    "number": "1255779385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 N CAMPBELL AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857194330",
            "telephone_number": "520-626-7053",
            "fax_number": "520-626-6986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 N CAMPBELL AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85719",
            "telephone_number": "520-626-7053",
            "fax_number": "520-626-6986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMES",
        "first_name": "MICHELINA",
        "middle_name": "DE LA MAZA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-11",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "AZ",
            "license": "52155",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "52125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.