MAIN STREET PEDIATRICS
NPI 1073102976
Pediatrics in Mesa, AZ

NPI Status: Active since January 14, 2021

Contact Information

130 S 63RD ST
MESA, AZ
ZIP 85206
Phone: (480) 792-9200

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  • Organization
  • Pediatrics
  • CLIA Number: 03D2211642
  • CLIA Cert. Type: Physician Office
  • CLIA Exp. Date: 01-28-2027

About MAIN STREET PEDIATRICS

This page provides the complete NPI Profile along with additional information for Main Street Pediatrics, a pediatrician established in Mesa, Arizona operating as a Pediatrics. The healthcare provider is registered in the NPI registry with number 1073102976 assigned on January 2021. The practitioner's primary taxonomy code is 208000000X. The provider is registered as an organization and their NPI record was last updated 5 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The provider's is doing business as Main Street Pediatrics. The authorized official of this NPI record is Stacie Self (Billing)

NPI
1073102976
Provider Legal Name
BETHESDA PEDIATRICS OF QUEEN CREEK
Other Organization Name
MAIN STREET PEDIATRICS
Other Name Type
Doing Business As (3)
Entity Type
Organization
Location Address
130 S 63RD ST MESA, AZ 85206
Location Phone
(480) 792-9200
Mailing Address
22707 S ELLSWORTH RD STE H101 QUEEN CREEK, AZ 85142
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
01-14-2021
Last Update Date
01-20-2021
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A pediatrician like Main Street Pediatrics is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, etc.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Pediatrics

Taxonomy Code
208000000X
Type
Allopathic & Osteopathic Physicians
Taxonomy Description
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.

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

STACIE SELF

Authorized Official Title
BILLING
Authorized Official Phone
(480) 792-9200

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
538751MEDICAID (05)AZ 

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
03D2211642
Facility Type
Physician Office
Certificate Effective Date
January 29, 2025
Certificate Expiration Date
January 28, 2027
Laboratory Director
EMILIA GOMEZ-VIEYTEZ
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Main Street Pediatrics to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

Reviews for MAIN STREET PEDIATRICS

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1073102976, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 54. The final step is to find the difference between that total and the next multiple of ten (60 - 54 = 6).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
0
Unchanged
Pos 3
7
Doubled → 14 → 1 + 4
Pos 4
3
Unchanged
Pos 5
1
Doubled → 2
Pos 6
0
Unchanged
Pos 7
2
Doubled → 4
Pos 8
9
Unchanged
Pos 9
7
Doubled → 14 → 1 + 4
Check
6
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 7 → 14 → 5 1 → 2 2 → 4 7 → 14 → 5

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 0 + 1 + 4 + 3 + 2 + 0 + 4 + 9 + 1 + 4 + 24 = 54

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 54 is 60. The difference is the calculated check digit.

60 - 54 = 6
This NPI is valid
The calculated check digit is 6, which matches the last digit of 1073102976.

Other Providers at the Same Location


The following 7 providers are registered at the same or a nearby location.

Nurse Practitioner
130 S 63RD ST, BLDG 3 SUITE 114
MESA, AZ 85206
Urology
130 S 63RD ST, SUITE #101
MESA, AZ 85206
Urology
130 S 63RD ST, SUITE #101
MESA, AZ 85206
Dermatology
130 S 63RD ST, BLDG 3 STE 114
MESA, AZ 85206
Nurse Practitioner (Acute Care)
130 S 63RD ST, STE 106
MESA, AZ 85206
Family Medicine
130 S 63RD ST
MESA, AZ 85206
Dermatology
130 S 63RD ST, SUITE 114
MESA, AZ 85206

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1073102976, enumerated as an "organization" on January 14, 2021.

The provider is located at 130 S 63RD ST MESA, AZ 85206 and the phone number is (480) 792-9200.

Pediatrics with taxonomy code 208000000X.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.