NPIMap

Organization Active NPI

Canyon Pediatrics, Inc

  • Primary Care Clinic/Center
  • Gilbert, AZ
National Provider Identifier
1831185362
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CANYON PEDIATRICS, INC
Practice address
2451 E Baseline Rd
Suite 200
Gilbert, AZ 85234-2471
Phone
(480) 507-2213
Fax
(480) 626-6508
NPI assigned
Sep 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2024

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) 776-7155

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Clinic/Center 261Q00000X
Primary Care Clinic/Center 261QP2300X Primary
Health Maintenance Organization 302R00000X 20136 AZ

Addresses

Primary practice location

2451 E Baseline Rd
Suite 200
Gilbert, AZ 85234-2471

Mailing address

2451 E Baseline Rd
Ste 130
Gilbert, AZ 85234-2471
Phone (480) 507-2213

Other practice location 1

815 E University Dr
Mesa, AZ 85203-8032
Phone (480) 776-7155

Other identifiers 6

IdentifierTypeStateIssuer
053504MedicaidAZ
AZ0889880OtherAZBLUE CROSS BLUE SHEILD
2048349OtherAZAETNA HEALTH CAER
183427266OtherAZTRICARE
6327185OtherAZCIGNA US HEALTH CARE
1Z5874OtherAZHEALTH NET

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

3130 E Baseline Rd
Ste 103
Mesa, AZ 85204
Phone (480) 539-7618

3305 E Greenway Rd
Ste 6
Phoenix, AZ 85032
Phone (602) 867-1252

3201 W Peoria Ave
Ste D805
Phoenix, AZ 85029
Phone (602) 569-5437

Practitioners & affiliated clinicians

Practitioners 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1831185362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2451 E BASELINE RD",
            "address_2": "STE 130",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342471",
            "telephone_number": "480-507-2213",
            "fax_number": "480-626-6508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2451 E BASELINE RD",
            "address_2": "SUITE 200",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342471",
            "telephone_number": "480-507-2213",
            "fax_number": "480-626-6508"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "815 E University Dr",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852038032",
            "country_code": "US",
            "telephone_number": "480-776-7155",
            "fax_number": "480-626-6508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CANYON PEDIATRICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-20",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A",
        "authorized_official_last_name": "BRUBAKER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-776-7155",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "AZ",
            "license": "20136",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053504",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "AZ0889880",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTH CAER",
            "identifier": "2048349",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "183427266",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA US HEALTH CARE",
            "identifier": "6327185",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "1Z5874",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; 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.