NPIMap

Organization Active NPI

Phoenix Children's Medical Group

  • Multi-Specialty Clinic/Center
  • Scottsdale, AZ
National Provider Identifier
1316203383
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
SH3107 Issued in AZ
Legal business name
PHOENIX CHILDREN'S MEDICAL GROUP
Practice address
6990 E Shea Blvd
Scottsdale, AZ 85254-5200
Phone
(602) 933-0004
Fax
(602) 933-6151
NPI assigned
Apr 4, 2012
Last updated
May 22, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PHOENIX CHILDREN'S HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 22, 2023

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 & Payor Strategy
Phone
(602) 933-3548

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X SH3107 AZ Primary

Addresses

Primary practice location

6990 E Shea Blvd
Scottsdale, AZ 85254-5200

Mailing address

2108 E Thomas Rd Ste 130
Phoenix, AZ 85016-0008

Other identifiers 1

IdentifierTypeStateIssuer
876253MedicaidAZ

Other names 1

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

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Children's Hospital Inc3 organizations share this tax ID, including this one
Part of
GSMC Phoenix Childrens

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1333497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1316203383",
    "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": "6990 E SHEA BLVD",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852545200",
            "telephone_number": "602-933-0004",
            "fax_number": "602-933-6151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX CHILDREN'S MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOENIX CHILDREN'S HOSPITAL, INC.",
        "enumeration_date": "2012-04-04",
        "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 & PAYOR 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 - Scottsdale",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Phoenix Children's Ambulatory Specialty Center - Scottsdale",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Scottsdale, AZ

Sources for this page

  • 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.