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PEDIATRICS OF QUEEN CREEK
NPI 1063727766
Pediatrics in Queen Creek, AZ

Active since August 18, 2010CLIA 03D1046327 · Waiver
22707 S ELLSWORTH RD STE H101, QUEEN CREEK, AZ 85142(480) 792-9200(480) 792-9206 Get Directions Write a Review

NPPES record last updated: July 24, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 24, 2024, Mar 23, 2021 (2 updates tracked since 2021).

About Pediatrics Of Queen Creek NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PEDIATRICS OF QUEEN CREEK (NPI 1063727766) is a healthcare organization registered as a pediatrics in Queen Creek, Arizona and active in the NPI registry since August 2010. The organization holds a CLIA Waiver certificate valid through October 4, 2027, maintains 2 additional practice locations, and lists Elmer Portillo, Cfo, as its authorized official.

NPPES Registry Identity

NPI1063727766
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameBETHESDA PEDIATRICS OF QUEEN CREEK
Location Address22707 S ELLSWORTH RD STE H101Queen Creek, AZ 85142-7568
Mailing Address22707 S Ellsworth Rd Ste H101Queen Creek, AZ 85142-7568 · (480) 792-9200 · Fax (480) 792-9206
Phone(480) 792-9200
Fax(480) 792-9206
Organization SubpartNo
Authorized OfficialElmer PortilloCfo · (602) 531-0302
Enumeration DateAugust 18, 2010
Last NPPES UpdateJuly 24, 20242 updates tracked since enumeration
NPPES CertifiedJuly 24, 2024
✔ NPI 1063727766 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in AZ · 43623
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
22707 S ELLSWORTH RD STE H101, Queen Creek, AZ 85142
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Other Names 1

Doing Business AsPediatrics Of Queen Creek

Secondary Practice Locations 2

Location 1299 W Central AveCoolidge, AZ 85128-4724 · Phone (520) 723-1939
Location 2130 S 63rd StMesa, AZ 85206-1620 · Phone (480) 792-9200

Other Identifiers 1

Medicaid935531AZ

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 03D1046327

Bethesda Pediatrics Of Queen Creek · Queen Creek, AZ
Active · expires Oct 4, 2027
CLIA Number03D1046327
Laboratory TypePhysician Office
Certificate Effective DateOctober 5, 2025
Certificate Expiration DateOctober 4, 2027
Laboratory DirectorEmilia Gomez Vieytez
Laboratory Phone(480) 792-9200
Laboratory LocationBethesda Pediatrics Of Queen Creek22707 S Ellsworth Rd H-101, Queen Creek, AZ 85142
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMBER LYNEE ALLEN
Nurse Practitioner
22707 S ELLSWORTH RD STE H101
QUEEN CREEK, AZ 85142
Maricopa County (480) 792-9200
LUIS JAVIER BRAVO PAGAN MD
Pediatrics
22707 S ELLSWORTH RD STE H101
QUEEN CREEK, AZ 85142
Maricopa County (480) 792-9200
CASSANDRA HODO NP-C
Nurse Practitioner (Family)
22707 S ELLSWORTH RD STE H101
QUEEN CREEK, AZ 85142
Maricopa County (480) 792-9200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bethesda Pediatrics Of Queen Creek's NPI number?

The NPI number for Bethesda Pediatrics Of Queen Creek is 1063727766. It was assigned to this organization in the NPPES registry on August 18, 2010. The provider is doing business as Pediatrics Of Queen Creek.

Where is Bethesda Pediatrics Of Queen Creek located?

Bethesda Pediatrics Of Queen Creek is located at 22707 S Ellsworth Rd Ste H101, Queen Creek, AZ 85142. The listed phone number is (480) 792-9200.

What is Bethesda Pediatrics Of Queen Creek's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Bethesda Pediatrics Of Queen Creek hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D1046327) is associated with this NPI, valid through October 4, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Bethesda Pediatrics Of Queen Creek accept?

Health plans from Ambetter from Arizona Complete Health list Bethesda Pediatrics Of Queen Creek as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Bethesda Pediatrics Of Queen Creek was last updated on July 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.