Individual provider Active NPI

Alisha Moreno, M.D.

  • Pediatrics Physician
  • Glendale, AZ
National Provider Identifier
1588026132
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
67596 Issued in AZ
Practice address
5555 W Thunderbird Rd
Glendale, AZ 85306-4622
Phone
(602) 856-5570
NPI assigned
Mar 23, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35.136804 OH
Hospitalist Physician 208M00000X 67596 AZ
Hospitalist Physician 208M00000X 35.136804 OH
Pediatrics Physician 208000000X 67596 AZ Primary

Addresses

Primary practice location

5555 W Thunderbird Rd
Glendale, AZ 85306-4622

Mailing address

5555 W Thunderbird Rd
Glendale, AZ 85306-4622
Phone (602) 856-5570

Other identifiers 1

IdentifierTypeStateIssuer
0359799MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, AZ2 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
I20200527000812 OH Practitioner - Hospitalist 8628499886 Reassigns benefits to 1 organization
I20221004002202 AZ Practitioner - Pediatric Medicine 8628499886 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
67596AZMDHospitalist Physician
35.136804OHMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dayton Children'S Specialty Physicians, Inc. Pediatrics CurrentSince May 1, 2020 Accepting new patients
Banner Physician Super Specialists Arizona LLC CurrentSince Nov 1, 2022 Accepting new patients
Banner Physician Super Specialists Arizona LLC Current Accepting new patients
Banner Physician Super Specialists Arizona LLC CurrentSince Nov 1, 2022 Accepting new patients
Dayton Children'S Specialty Physicians, Inc. Pediatrics CurrentSince May 1, 2020 Accepting new patients
Banner Estrella Medical Center Past Accepting new patients
Banner - University Medical Center Phoenix Past Accepting new patients
Banner Thunderbird Medical Center Past Accepting new patients

Locations

5555 W Thunderbird Rd
Glendale, AZ 85306
Phone (602) 588-5555

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

1432 S Dobson Rd
Ste 301
Mesa, AZ 85202
Phone (480) 412-7120

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

14502 W Meeker Blvd
Sun City West, AZ 85375
Phone (623) 214-4000

1 Childrens Plz
Dayton, OH 45404
Phone (937) 641-3600

967 Bellefontaine Ave
Lima, OH 45804
Phone (419) 224-1330

Organizations & group practices 8

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": "1458691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746748800000",
    "number": "1588026132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 W THUNDERBIRD RD",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064622",
            "telephone_number": "602-856-5570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 W THUNDERBIRD RD",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064622",
            "telephone_number": "602-856-5570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO",
        "first_name": "ALISHA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-23",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.136804",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "AZ",
            "license": "67596",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OH",
            "license": "35.136804",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "67596",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0359799",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.