NPIMap

Organization Active NPI

Phoenix Children's Hospital

Doing business as Phoenix Children's Hospital - Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1457402364
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
MED2169 Issued in AZ
Legal business name
PHOENIX CHILDREN'S HOSPITAL
Doing business as
Phoenix Children's Hospital - Dialysis Center
Practice address
1920 E Cambridge Ave
Ste 102
Phoenix, AZ 85006-1459
Phone
(602) 933-3220
Fax
(602) 933-0502
NPI assigned
Jan 16, 2007
Last updated
May 22, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PHOENIX CHILDREN'S HOSPITALAs 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X OTC 3741 AZ
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X MED2169 AZ Primary

Addresses

Primary practice location

1920 E Cambridge Ave
Ste 102
Phoenix, AZ 85006-1459

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
MED2169OtherAZAZ DEPT OF HEALTH SERVICES

Other names 1

  • Phoenix Children's Hospital - Dialysis Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030502000042 AZ Part A Provider - End-Stage Renal Disease Facility (ESRD) 9436069291 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phoenix, AZ

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Children's Hospital Inc9 organizations share this tax ID, including this one
Part of
Phoenix Children's Hospital Inc

Other organizations with this tax ID 8

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

Locations

725 Welch Rd
Ste MC5519
Palo Alto, CA 94304

2521 Stockton Blvd
Ste 5200
Sacramento, CA 95817
Phone (916) 734-2801

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1457402364",
    "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": "1920 E CAMBRIDGE AVE",
            "address_2": "STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850061459",
            "telephone_number": "602-933-3220",
            "fax_number": "602-933-0502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX CHILDREN'S HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOENIX CHILDREN'S HOSPITAL",
        "enumeration_date": "2007-01-16",
        "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": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "AZ",
            "license": "OTC 3741",
            "primary": false
        },
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "AZ",
            "license": "MED2169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ DEPT OF HEALTH SERVICES",
            "identifier": "MED2169",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Children's Hospital - Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Phoenix Children's Hospital - Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 22, 2023; 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.