Individual provider Active NPI

Javier Fortunato Cardenas, M.D.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Phoenix, AZ
National Provider Identifier
1447445440
Registry record updated Aug 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
36579 Issued in AZ
Practice address
222 W Thomas Rd
Suite 304
Phoenix, AZ 85013-4419
Phone
(602) 406-4323
NPI assigned
Sep 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 81042 AZ
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 36579 AZ Primary

Addresses

Primary practice location

222 W Thomas Rd
Suite 304
Phoenix, AZ 85013-4419

Mailing address

222 W Thomas Rd #304
Phoenix, AZ 85013
Phone (602) 406-4323

Other identifiers 1

IdentifierTypeStateIssuer
259914MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, WV2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20090724000138 AZ Practitioner - NeurologyPractitioner - Pediatric Medicine 7315090206 Reassigns benefits to 1 organization
I20230609001528 WV Practitioner - Neurology 7315090206 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Arizona College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
West Virginia University Medical CorporationGroup PAC ID 1052224565, 1,974 clinicians

Practice addresses (Care Compare)

33 Medical Ctr Dr
Morgantown, WV 26505-4024
Phone (304) 598-6127

Hospital & facility affiliations

  • West Virginia University Hospitals, Inc Hospital, Morgantown, WV, CCN 510001

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
81042AZMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia University Medical Corporation Family Medicine CurrentSince Apr 28, 2023 Accepting new patients
Phoenix Children'S Hospital Current Accepting new patients
West Virginia University Medical Corporation CurrentSince Apr 28, 2023 Accepting new patients
Phoenix Children'S Medical Group CurrentSince Dec 14, 2013 Accepting new patients
Phoenix Children'S Medical Group CurrentSince Dec 14, 2013 Accepting new patients

Locations

350 W Thomas Rd
Phoenix, AZ 85013
Phone (480) 339-5001

240 W Thomas Rd
#301
Phoenix, AZ 85013
Phone (602) 406-6262

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

33 Medical Center Dr
Morgantown, WV 26505
Phone (304) 293-0822

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1447445440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 W THOMAS RD #304",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85013",
            "telephone_number": "602-406-4323",
            "fax_number": "602-406-3810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W THOMAS RD",
            "address_2": "SUITE 304",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134419",
            "telephone_number": "602-406-4323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARDENAS",
        "first_name": "JAVIER",
        "middle_name": "FORTUNATO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-12",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "AZ",
            "license": "81042",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "AZ",
            "license": "36579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "259914",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.