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Phoenix Children'S Hospital

Organization Active NPI Children's Hospital · Phoenix, AZ

NPI 1760480503 · NPPES record last updated May 22, 2023

Key facts

NPI
1760480503
Entity type
Organization (NPI type 2)
Primary specialty
Children's Hospital 282NC2000X
License
SH3107 (AZ)
Legal business name
PHOENIX CHILDREN'S HOSPITAL
Practice address
1919 E Thomas Rd
Phoenix, AZ 85016-7710
Phone
(602) 933-1000
NPI assigned
Jul 13, 2005
Organization subpart
No

Authorized official

Name
Raheel Farough
Title
SVP, Managed Care & Payor Strategy
Phone
(602) 933-3548

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 8

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Facilities with the same owner 52

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 52

Practitioners 207

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

View all 207

Affiliated clinicians 103

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 103

Medicare Care Compare: Hospital

Listed as
Phoenix Children'S Hospital CCN 033302
Type
Childrens
Ownership
Voluntary non-profit - Private
Medicare certification status
Active (Provider of Services file)
Emergency services
No

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in AZ

Hospital certification: CCN 033302

Legal name
PHOENIX CHILDREN'S HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Children’s
Participating since
May 24, 2002
Last certification
Oct 9, 2019
Beds
435
Ownership / control type
Private (not for profit)
Organization structure
Other · Non-profit
Incorporated
Jul 31, 1980 in AZ
Enrollment address
1919 E Thomas Rd
Phoenix, AZ 85016-7710
Main/Primary Hospital Location
Hospital subgroups
Children’s

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Dustin J Rayhorn
Individual 		Corporate Director Jan 1, 2024
W-2 Managing Employee Jan 1, 2024
Robert Delgado
Individual 		Corporate Director Jan 1, 2011
Richard Boals
Individual 		Corporate Director Feb 28, 2022
Dignity Health
Organization · San Francisco, CA
Non-profit 		5% Or Greater Direct Ownership Interest Mar 25, 2011 20%
Raheel Farough
Individual 		Corporate Director
SVP, Managed Care		 Feb 28, 2022
W-2 Managing Employee
SVP, Managed Care		 Feb 28, 2022
Robert Meyer
Individual 		Corporate Officer
Ceo		 May 1, 2003
Corporate Director May 1, 2003
W-2 Managing Employee May 1, 2003
David Lenhardt
Individual 		Corporate Director Mar 1, 2015
Chantal Morales
Individual 		W-2 Managing Employee
Supervisor, Provider Enrollment		 Apr 25, 2011
Michael Ebert
Individual 		Corporate Director Mar 1, 2015
Nathan C Page
Individual 		Corporate Director Jan 1, 2025
Childrens Healthcare of Arizona Inc
Organization · Phoenix, AZ
Non-profit 		5% Or Greater Direct Ownership Interest Apr 5, 2011 80%
Omar Alvarez
Individual 		Corporate Director Aug 1, 2023
George Getz
Individual 		Corporate Director Mar 1, 2015
Jon Hulburd
Individual 		Corporate Director Jan 1, 2008
Michelle Ann Bruhn
Individual 		Corporate Officer Apr 25, 2024
W-2 Managing Employee Jul 17, 2023
Carmen Neuberger
Individual 		Corporate Officer Apr 26, 2016
W-2 Managing Employee Aug 20, 2007
Molly Ryan Carson
Individual 		Corporate Director Feb 28, 2022

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20030502000042 AZ Part a Provider - End-Stage Renal Disease Facility (ESRD) 9436069291 1 other NPI on this enrollment
Practice locations: Phoenix, AZ
O20060622000234 AZ Part a Provider - Hospital 9436069291 Practice locations: Scottsdale, AZ; Phoenix, AZ; Gilbert, AZ; Mesa, AZ; Glendale, AZ; Avondale, AZ

National Provider Directory

Tax ID family
Phoenix Children'S Hospital Inc (9 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Children's Hospital 282NC2000X SH3107 AZ Yes

Addresses

Primary practice location

1919 E Thomas Rd
Phoenix, AZ 85016-7710

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
706707MedicaidAZ

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 22, 2023.

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1760480503",
    "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": "1919 E THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850167710",
            "telephone_number": "602-933-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX CHILDREN'S HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "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": "282NC2000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Children",
            "state": "AZ",
            "license": "SH3107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "706707",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

All providers in Phoenix, AZ · Children's Hospital in Arizona

Sources for this page

Verify at the official NPI Registry.