Christian Care Medical Foundation

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

CHRISTIAN CARE MEDICAL FOUNDATION

Doing business as

Mi Doctor Familiar

Practice address

5418 E Skyline Dr
San Tan Valley, AZ 85140-9000

Phone

(480) 776-9417

Fax

(480) 907-2110

NPI assigned

Jun 29, 2021

Last updated

Jan 11, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

CHRISTIAN CARE MEDICAL FOUNDATIONAs reported in NPPES

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

Authorized official

Name

Humberto Robert Inzunza, PHYSICIAN ASSISTANT

Title

Ceo

Phone

(480) 776-9417

Specialties & licenses 6

Addresses

Other identifiers 3

Other names 1

• Mi Doctor Familiar Doing business as

Electronic endpoints 1

Part of

Christian Care Medical Foundation

Locations

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

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673395200000",
    "number": "1548830789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5330 E SKYLINE DR",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851409023",
            "telephone_number": "480-776-9417",
            "fax_number": "323-313-0317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5418 E SKYLINE DR",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851409000",
            "telephone_number": "480-776-9417",
            "fax_number": "480-907-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTIAN CARE MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHRISTIAN CARE MEDICAL FOUNDATION",
        "enumeration_date": "2021-06-29",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A",
        "authorized_official_last_name": "INZUNZA",
        "authorized_official_first_name": "HUMBERTO",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-776-9417",
        "authorized_official_credential": "PHYSICIAN ASSISTANT"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUNIL R KURUP MD   NPI",
            "identifier": "1952532988",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254343",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMBERTO R INZUNZA PA-C   NPI",
            "identifier": "1528356441",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "MiDoctorFamiliar2020@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Clinic Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5418 E Skyline Dr",
            "city": "San Tan Valley",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "851409000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mi Doctor Familiar",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mi Doctor Familiar",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Chargualaf, FNP
• Bianca Chavez
• Kenna Suzanne Chesney
• Chelsea Choat, M.S.
• Orchideh Christensen, BCBA, LBA
• Chuck Combs FNP PLLC (Arizona Mobile NP)
• Paige Figa Church, FNP-C
• Clasik Vision Care PLLC
• Krista Dawn Claypool, RN
• Shannon Rachelle Clint, FNP-C

• Geriatric Medicine (Family Medicine) Physician in San Tan Valley, AZ
• Providers in San Tan Valley, AZ by specialty
• Geriatric Medicine (Family Medicine) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.