NPIMap

Organization Active NPI

Fountains Family Care, P.C.

  • Family Medicine Physician
  • Chandler, AZ
National Provider Identifier
1104004183
Registry record updated Apr 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FOUNTAINS FAMILY CARE, P.C.
Practice address
3930 S Alma School Rd
Ste 1
Chandler, AZ 85248-4510
Phone
(480) 726-6632
Fax
(480) 726-3868
NPI assigned
Feb 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2015

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

Authorized official

Name
Dr. Richard K Le, D.O.NPI 1851393003
Title
President
Phone
(480) 726-6632

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X

Addresses

Primary practice location

3930 S Alma School Rd
Ste 1
Chandler, AZ 85248-4510

Mailing address

3930 S Alma School Rd
Ste 1
Chandler, AZ 85248-4510
Phone (480) 726-6632

Other identifiers 1

IdentifierTypeStateIssuer
989527MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060131000427 AZ Part B Supplier - Clinic/Group Practice 4880608710 Receives reassigned benefits from 15 practitioners
Practice locations: Chandler, AZ

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
03D1051562Fountains Family Care PC3930 S Alma School Rd #1, Chandler, AZ 85248Certificate of waiverMar 5, 2028

National Provider Directory

National Provider Directory

Locations

4708 E Van Buren St
Ste 107
Phoenix, AZ 85008

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": "1201824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428451200000",
    "number": "1104004183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3930 S ALMA SCHOOL RD",
            "address_2": "STE 1",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852484510",
            "telephone_number": "480-726-6632",
            "fax_number": "480-726-3868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 S ALMA SCHOOL RD",
            "address_2": "STE 1",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852484510",
            "telephone_number": "480-726-6632",
            "fax_number": "480-726-3868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAINS FAMILY CARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-01",
        "last_updated": "2015-04-08",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-726-6632",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "989527",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.