Individual provider Active NPI

Zaydee Montano Rivera, MD

  • Pediatrics Physician
  • Queen Creek, AZ
National Provider Identifier
1427579754
Registry record updated Apr 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
60556 Issued in AZ
Practice address
21772 S Ellsworth Loop Rd
Queen Creek, AZ 85142-7709
Phone
(370) 048-0512
NPI assigned
Jun 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 34503 PR
Pediatrics Physician 208000000X 60556 AZ Primary

Addresses

Primary practice location

21772 S Ellsworth Loop Rd
Queen Creek, AZ 85142-7709

Mailing address

1684 Calle Marquesa
Ponce, PR 00716-0504
Phone (480) 227-2544

Other practice location 1

917 Ave Tito Castro
Ponce, PR 00716-4717
Phone (787) 844-2080 ext. 1649

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
I20201008000924 AZ Practitioner - Pediatric Medicine 4385063577 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60556AZMDPediatrics Physician
34503PRMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Childrens Banner Health Clinic LLC CurrentSince Sep 6, 2020 Accepting new patients
Banner Childrens Banner Health Clinic LLC Current Accepting new patients
Banner Primary Care Physicians Arizona LLC CurrentSince Mar 1, 2020 Accepting new patients
Banner Childrens Banner Health Clinic LLC CurrentSince Sep 6, 2020 Accepting new patients
Banner Primary Care Physicians Arizona LLC CurrentSince Mar 1, 2020 Accepting new patients

Locations

7400 S Power Rd
Ste 140
Gilbert, AZ 85297
Phone (480) 590-1442

17900 N Porter Rd
Maricopa, AZ 85138
Phone (520) 233-2500

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

13640 N Plaza del Rio Blvd
Peoria, AZ 85381
Phone (623) 876-3800

21772 S Ellsworth Loop Rd
Queen Creek, AZ 85142
Phone (480) 512-3700

14416 W Meeker Blvd
Sun City West, AZ 85375
Phone (623) 583-5083

Organizations & group practices 5

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": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586995200000",
    "number": "1427579754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1684 CALLE MARQUESA",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007160504",
            "telephone_number": "480-227-2544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21772 S ELLSWORTH LOOP RD",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851427709",
            "telephone_number": "370-048-0512"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "917 Ave Tito Castro",
            "address_purpose": "LOCATION",
            "city": "Ponce",
            "state": "PR",
            "postal_code": "007164717",
            "country_code": "US",
            "telephone_number": "787-844-2080 x1649",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "ZAYDEE",
        "middle_name": "MONTANO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-27",
        "last_updated": "2020-04-16",
        "certification_date": "2020-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PR",
            "license": "34503",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "60556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Queen Creek, AZ

Sources for this page

Verify at the official NPI Registry.