NPIMap

Organization Active NPI

Phoenix Children's Hospital

  • Children's Hospital
  • Phoenix, AZ
National Provider Identifier
1760480503
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's HospitalTaxonomy code 282NC2000X
License
SH3107 Issued in 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
Last updated
May 22, 2023By the provider in NPPES
Organization subpart
No

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
Children's Hospital 282NC2000X SH3107 AZ Primary

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 1

IdentifierTypeStateIssuer
706707MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

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

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1760480503. Details of each certification follow.

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
OtherNon-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

Hospital certification: CCN 039804

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PHOENIX CHILDRENS HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Transplant
Participating since
Apr 16, 2010
Last certification
Nov 8, 2023
Facility address
1919 East Thomas Road
Phoenix, AZ 85016

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Phoenix Children's HospitalCCN 033302 · All quality measures
Type
Childrens
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
GSMC Phoenix Childrens9 organizations share this tax ID, including this one

Other organizations with this 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.

  • Dignity Health

    dba St. Rose Dominican Hospital, Rose de Lima Campus

    • General Acute Care Hospital
    • Henderson, NV
    • NPI 1447393152

    Member Of

    NPD member

Ownership & related parties

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 DirectorSVP, Managed Care Feb 28, 2022
W-2 Managing EmployeeSVP, Managed Care Feb 28, 2022
Robert Meyer Individual Corporate OfficerCeo 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 EmployeeSupervisor, 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

Owners & managing parties with NPI records 2

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

Facilities with the same owner 52

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

View all 52

Practitioners & affiliated clinicians

Practitioners 207

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 207

Affiliated clinicians 103

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

View all 103

NPI Registry JSON

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

{
    "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

Sources for this page

Verify at the official NPI Registry.