NPIMap

Organization Active NPI

Gofan Healthcare Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Oro Valley, AZ
National Provider Identifier
1598415218
Registry record updated Mar 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
GOFAN HEALTHCARE SERVICES LLC
Practice address
1846 E Innovation Park Dr Ste 100
Oro Valley, AZ 85755-1963
Phone
(972) 824-7874
NPI assigned
Mar 25, 2022
Last updated
Mar 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2022

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

Authorized official

Name
Jacinta MaduNPI 1497357578
Title
Owner
Phone
(972) 824-7874

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Primary

Addresses

Primary practice location

1846 E Innovation Park Dr Ste 100
Oro Valley, AZ 85755-1963

Mailing address

1846 E Innovation Park Dr Ste 100
Oro Valley, AZ 85755-1963
Phone (972) 824-7874

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220509000228 AZ Part B Supplier - Clinic/Group Practice 9234526260 Receives reassigned benefits from 1 practitioner
Practice locations: Phoenix, AZ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Gofan Healthcare Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1648166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648166400000",
    "number": "1598415218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1846 E INNOVATION PARK DR STE 100",
            "city": "ORO VALLEY",
            "state": "AZ",
            "postal_code": "857551963",
            "telephone_number": "972-824-7874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1846 E INNOVATION PARK DR STE 100",
            "city": "ORO VALLEY",
            "state": "AZ",
            "postal_code": "857551963",
            "telephone_number": "972-824-7874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOFAN HEALTHCARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-25",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A",
        "authorized_official_last_name": "MADU",
        "authorized_official_first_name": "JACINTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-824-7874"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oro Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.