NPIMap

Organization Active NPI

St. Luke's Pediatrics

  • Primary Care Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1306078514
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ST. LUKE'S PEDIATRICS
Practice address
1310 N 24TH St Ste 150
Phoenix, AZ 85008-4617
Phone
(602) 254-0200
Fax
(602) 254-0237
NPI assigned
Aug 20, 2009
Last updated
Jan 31, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
ARIZONA FAMILY CLINICS CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Authorized official

Name
Dr. Gustavo Emilio Dalotto
Title
Owner/Ceo
Phone
(602) 254-0200

Specialties & licenses 1

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

Addresses

Primary practice location

1310 N 24TH St Ste 150
Phoenix, AZ 85008-4617

Mailing address

1310 N 24TH St Ste 150
Phoenix, AZ 85008-4617
Phone (602) 254-0200

Other practice location 1

727 E Bethany Home Rd Ste D118
Phoenix, AZ 85014-2194
Phone (602) 254-0200

Other identifiers 1

IdentifierTypeStateIssuer
526031MedicaidAZ

Other names 1

  • Arizona Family Clinics Corp Other name

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
03D2000921St Luke's Pediatrics1310 N 24TH St Ste 150, Phoenix, AZ 85008Certificate of waiverDec 8, 2027

National Provider Directory

National Provider Directory
Part of
Arizona Family Clinics Corp

Locations

1310 N 24th St
#150
Phoenix, AZ 85008
Phone (602) 254-0200

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1306078514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 N 24TH ST STE 150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850084617",
            "telephone_number": "602-254-0200",
            "fax_number": "602-254-0237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 N 24TH ST STE 150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850084617",
            "telephone_number": "602-254-0200",
            "fax_number": "602-254-0237"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "727 E Bethany Home Rd Ste D118",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850142194",
            "country_code": "US",
            "telephone_number": "602-254-0200",
            "fax_number": "602-254-0237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. LUKE'S PEDIATRICS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ARIZONA FAMILY CLINICS CORP",
        "enumeration_date": "2009-08-20",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A",
        "authorized_official_last_name": "DALOTTO",
        "authorized_official_first_name": "GUSTAVO",
        "authorized_official_middle_name": "EMILIO",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "602-254-0200",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "526031",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arizona Family Clinics Corp",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Arizona Family Clinics Corp",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jan 31, 2023; 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.