NPIMap

Organization Active NPI

Canyon Pediatrics, Inc

  • Pediatrics Physician
  • Mesa, AZ
National Provider Identifier
1780449348
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CANYON PEDIATRICS, INC
Practice address
815 E University Dr
Mesa, AZ 85203-8032
Phone
(480) 776-7155
NPI assigned
Feb 13, 2024
Last updated
Mar 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

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

Authorized official

Name
Richard Brubaker, LMSWNPI 1285036798
Title
Ceo
Phone
(480) 507-2199

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Primary Care Clinic/Center 261QP2300X
Health Maintenance Organization 302R00000X

Addresses

Primary practice location

815 E University Dr
Mesa, AZ 85203-8032

Mailing address

2451 E Baseline Rd Ste 130
Gilbert, AZ 85234-2487
Phone (480) 776-7155

National Provider Directory

National Provider Directory
Tax ID family
Canyon Pediatrics4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

815 E University Dr
Mesa, AZ 85203
Phone (480) 507-2199

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742169600000",
    "number": "1780449348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2451 E BASELINE RD STE 130",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342487",
            "telephone_number": "480-776-7155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 E UNIVERSITY DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852038032",
            "telephone_number": "480-776-7155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON PEDIATRICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-13",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A",
        "authorized_official_last_name": "BRUBAKER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-507-2199",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.