NPIMap

Organization Active NPI

Jackrabbit Family Medicine Inc

  • Primary Care Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1427258706
Registry record updated Jan 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
22811 Issued in AZ
Legal business name
JACKRABBIT FAMILY MEDICINE INC
Practice address
4141 N 32ND St
Suite 105
Phoenix, AZ 85018-4775
Phone
(602) 279-2337
Fax
(602) 448-8321
NPI assigned
Jul 24, 2007
Last updated
Jan 3, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2019

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

Authorized official

Name
Dr. Gabrielle Julie Goodrick, MDNPI 1285686469
Title
President
Phone
(602) 279-2337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 22811 AZ Primary

Addresses

Primary practice location

4141 N 32ND St
Suite 105
Phoenix, AZ 85018-4775

Mailing address

4141 N 32ND St
Suite 105
Phoenix, AZ 85018-4775
Phone (602) 279-2337

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
03D0971549Jackrabbit Family Medicine PC4141 N 32ND St Ste 105, Phoenix, AZ 85018Certificate of waiverMar 28, 2028

National Provider Directory

National Provider Directory

Locations

4141 N 32nd St
Ste 105
Phoenix, AZ 85018
Phone (602) 279-2337

5040 N 15th Ave
Ste 303
Phoenix, AZ 85015
Phone (602) 279-2337

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546473600000",
    "number": "1427258706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4141 N 32ND ST",
            "address_2": "SUITE 105",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850184775",
            "telephone_number": "602-279-2337",
            "fax_number": "602-448-8321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4141 N 32ND ST",
            "address_2": "SUITE 105",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850184775",
            "telephone_number": "602-279-2337",
            "fax_number": "602-448-8321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKRABBIT FAMILY MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-24",
        "last_updated": "2019-01-03",
        "status": "A",
        "authorized_official_last_name": "GOODRICK",
        "authorized_official_first_name": "GABRIELLE",
        "authorized_official_middle_name": "JULIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-279-2337",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "22811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; 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.