The Good Samaritan Jati Clinic LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

THE GOOD SAMARITAN JATI CLINIC LLC

Practice address

2104 E Washington St Ste 128
Indianapolis, IN 46201-4131

Phone

(786) 865-3586

Fax

(617) 990-1707

NPI assigned

Oct 5, 2026

Last updated

Oct 5, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jackson Taravine, PA

Title

Member

Phone

(786) 865-3586

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1791158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791158400000",
    "number": "1033013966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 E WASHINGTON ST STE 128",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462014131",
            "telephone_number": "786-865-3586",
            "fax_number": "617-990-1707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 E WASHINGTON ST STE 128",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462014131",
            "telephone_number": "786-865-3586",
            "fax_number": "617-990-1707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE GOOD SAMARITAN JATI CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-05",
        "last_updated": "2026-10-05",
        "certification_date": "2026-10-05",
        "status": "A",
        "authorized_official_last_name": "TARAVINE",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "786-865-3586",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.