NPIMap

Organization Active NPI

Phoenix Children'S Medical Group

  • Multi-Specialty Clinic/Center
  • Glendale, AZ
National Provider Identifier
1679703441
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
SH3107 Issued in AZ
Legal business name
PHOENIX CHILDREN'S MEDICAL GROUP
Practice address
20325 N 51St Ave
Ste 116
Glendale, AZ 85308-5674
Phone
(602) 933-0003
Fax
(602) 933-6152
NPI assigned
Jul 15, 2009
Organization subpart
Yes
Parent organization
PHOENIX CHILDREN'S HOSPITAL, INC.As 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X SH3107 AZ Primary

Addresses

Primary practice location

20325 N 51St Ave
Ste 116
Glendale, AZ 85308-5674

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
876253MedicaidAZ

Other names 1

  • Phoenix Children's Ambulatory Specialty Center - Northwest Valley Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051107000704 AZ Part B Supplier - Clinic/Group Practice 0446278584 Receives reassigned benefits from 1,494 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phoenix, AZ; Safford, AZ; Scottsdale, AZ; Tempe, AZ; Tucson, AZ; Mesa, AZ; Peoria, AZ; Avondale, AZ…

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
Phoenix Children'S Hospital Inc

Practitioners & affiliated clinicians

Practitioners 457

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 457

NPI Registry JSON

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

{
    "created_epoch": "1247616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1679703441",
    "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": "20325 N 51ST AVE",
            "address_2": "STE 116",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853085674",
            "telephone_number": "602-933-0003",
            "fax_number": "602-933-6152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX CHILDREN'S MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOENIX CHILDREN'S HOSPITAL, INC.",
        "enumeration_date": "2009-07-15",
        "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": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "AZ",
            "license": "SH3107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "876253",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Children's Ambulatory Specialty Center - Northwest Valley",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Phoenix Children's Ambulatory Specialty Center - Northwest Valley",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Glendale, 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.