NPIMap

Organization Active NPI

Banner Childrens Banner Health Clinic LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1285278077
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
BANNER CHILDRENS BANNER HEALTH CLINIC LLC
Practice address
2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702
Phone
(602) 747-4000
NPI assigned
Nov 5, 2019
Last updated
Sep 13, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BANNER HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

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

Authorized official

Name
Shiva Birdi
Title
Ceo
Phone
(480) 256-3336

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702

Mailing address

2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702

Other practice location 1

117 E Main St Ste A100
Payson, AZ 85541-4606
Phone (928) 596-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130315000131 AZ Part B Supplier - Clinic/Group Practice 2466697735 Receives reassigned benefits from 57 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mesa, AZ; Phoenix, AZ; Queen Creek, AZ; Scottsdale, AZ; Surprise, AZ; Goodyear, AZ; Glendale, AZ; Gilbert, AZ…

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Banner Childrens Banner Health Clinic LLC2 organizations share this tax ID, including this one
Part of
Big Horn Family Med

Other organizations with this tax ID 1

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

Locations

604 W Warner Rd
Ste D2
Chandler, AZ 85225
Phone (480) 855-0999

3921 E Baseline Rd
Ste 102
Gilbert, AZ 85234
Phone (480) 615-2010

9780 S Estrella Pkwy
Goodyear, AZ 85338
Phone (623) 474-8101

1450 S Dobson Rd
Ste B220
Mesa, AZ 85202
Phone (480) 827-5044

2152 S Vineyard
Ste B129
Mesa, AZ 85210
Phone (480) 827-5043

803 S Ponderosa St
Ste C
Payson, AZ 85541
Phone (855) 817-4687

13995 W Statler Blvd
Bldg 1
Surprise, AZ 85374
Phone (623) 478-3100

Practitioners & affiliated clinicians

Practitioners 60

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.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1572912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1285278077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N CENTRAL AVE STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 N CENTRAL AVE STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122702",
            "telephone_number": "602-747-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "117 E Main St Ste A100",
            "address_purpose": "LOCATION",
            "city": "Payson",
            "state": "AZ",
            "postal_code": "855414606",
            "country_code": "US",
            "telephone_number": "928-596-4500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BANNER CHILDRENS BANNER HEALTH CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2019-11-05",
        "last_updated": "2024-09-13",
        "certification_date": "2024-08-26",
        "status": "A",
        "authorized_official_last_name": "BIRDI",
        "authorized_official_first_name": "SHIVA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-256-3336"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "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 Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.