NPIMap

Organization Active NPI

Cactus Childrens Clinic PC

  • Pediatrics Physician
  • Glendale, AZ
National Provider Identifier
1891850145
Registry record updated Feb 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
32657 Issued in AZ
Legal business name
CACTUS CHILDRENS CLINIC PC
Practice address
5940 W Union Hills Dr
Suite D-100
Glendale, AZ 85308-1308
Phone
(602) 978-2500
Fax
(602) 938-2198
NPI assigned
Dec 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2011

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

Authorized official

Name
Mr. Jason D Vargas, MDNPI 1073678553
Title
Treasurer/Owner
Phone
(602) 978-2500

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 32657 AZ Primary

Addresses

Primary practice location

5940 W Union Hills Dr
Suite D-100
Glendale, AZ 85308-1308

Mailing address

5940 W Union Hills Dr
Suite D-100
Glendale, AZ 85308-1308
Phone (602) 978-2500

Other identifiers 1

IdentifierTypeStateIssuer
215112001MedicaidAZ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D0530953Cactus Childrens Clinic5940 W Union Hills Dr, Ste D-100, Glendale, AZ 85308Certificate of waiverFeb 3, 2028

National Provider Directory

National Provider Directory

Locations

5940 W Union Hills Dr
Ste D100
Glendale, AZ 85308
Phone (602) 678-2500

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296518400000",
    "number": "1891850145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5940 W UNION HILLS DR",
            "address_2": "SUITE D-100",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081308",
            "telephone_number": "602-978-2500",
            "fax_number": "602-938-2198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5940 W UNION HILLS DR",
            "address_2": "SUITE D-100",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081308",
            "telephone_number": "602-978-2500",
            "fax_number": "602-938-2198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CACTUS CHILDRENS CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2011-02-01",
        "status": "A",
        "authorized_official_last_name": "VARGAS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "TREASURER/OWNER",
        "authorized_official_telephone_number": "602-978-2500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "32657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "215112001",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Feb 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.