Individual provider Active NPI

Leandra Marie McCutcheon, NP

  • Pediatric Nurse Practitioner
  • Glendale, AZ
National Provider Identifier
1619586203
Registry record updated Apr 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
267906 Issued in AZ
Practice address
5555 W Thunderbird Rd
Glendale, AZ 85306-4622
Phone
(602) 865-5555
NPI assigned
Jul 29, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 267906 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) 865-5555

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220526001729 AZ Practitioner - Nurse Practitioner 5698153070 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
267906AZMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Banner-University Medical Group Current Accepting new patients
Banner - University Super Specialists LLC CurrentSince Jun 1, 2022 Accepting new patients
Banner-University Medical Group CurrentSince Feb 24, 2025 Accepting new patients
Banner-University Medical Group CurrentSince Feb 24, 2025 Accepting new patients

Locations

5757 W Thunderbird Rd
Ste E250
Glendale, AZ 85306
Phone (602) 865-4470

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

1432 S Dobson Rd
Ste 107
Mesa, AZ 85202
Phone (480) 412-4100

755 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 271-5111

2800 E Ajo Way
Tucson, AZ 85713
Phone (520) 294-4471

1625 N Campbell Ave
Tucson, AZ 85719

Organizations & group practices 4

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": "1595980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649462400000",
    "number": "1619586203",
    "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": "602-865-5555"
        },
        {
            "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": "602-865-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCUTCHEON",
        "first_name": "LEANDRA",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-29",
        "last_updated": "2022-04-09",
        "certification_date": "2022-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AZ",
            "license": "267906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.