NPIMap

Organization Active NPI

Kachina Family Practice PA

Doing business as Kachina Family Medicine

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1467508432
Registry record updated Apr 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KACHINA FAMILY PRACTICE PA
Doing business as
Kachina Family Medicine
Practice address
16611 S 40TH St
Suite 120
Phoenix, AZ 85048
Phone
(480) 706-4100
Fax
(480) 706-2600
NPI assigned
Jan 25, 2007
Last updated
Apr 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2020

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

Authorized official

Name
Dr. Jaron Joseph Fischbeck, MDNPI 1760497325
Title
President
Phone
(480) 706-4100

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
Primary Care Clinic/Center 261QP2300X
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

16611 S 40TH St
Suite 120
Phoenix, AZ 85048

Mailing address

16611 S 40TH St
Suite 120
Phoenix, AZ 85048
Phone (480) 706-4100

Other names 1

  • Kachina Family Medicine Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL none Other

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040212000697 AZ Part B Supplier - Clinic/Group Practice 3274427802 Receives reassigned benefits from 5 practitioners
Practice locations: Phoenix, 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
03D0917901Kachina Family Practice PA16611 S 40TH St Ste 120, Phoenix, AZ 85048Provider-performed microscopyNov 30, 2027

National Provider Directory

National Provider Directory

Locations

16611 S 40th St
Ste 120
Phoenix, AZ 85048
Phone (480) 706-4100

4530 E Ray Rd
Phoenix, AZ 85044
Phone (480) 598-7940

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588204800000",
    "number": "1467508432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16611 S 40TH ST",
            "address_2": "SUITE 120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85048",
            "telephone_number": "480-706-4100",
            "fax_number": "480-706-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16611 S 40TH ST",
            "address_2": "SUITE 120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85048",
            "telephone_number": "480-706-4100",
            "fax_number": "480-706-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KACHINA FAMILY PRACTICE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A",
        "authorized_official_last_name": "FISCHBECK",
        "authorized_official_first_name": "JARON",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-706-4100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "none",
            "affiliation": "N",
            "endpointDescription": "none",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "none",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "none",
            "address_1": "16611 S 40th St",
            "address_2": "Suite 120",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "85048",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kachina Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 30, 2020; 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.