NPIMap

Organization Active NPI

MKG Internal Medicine PLLC

Doing business as Desert Rose Primary Care

  • Internal Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1619247939
Registry record updated Sep 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MKG INTERNAL MEDICINE PLLC
Doing business as
Desert Rose Primary Care
Practice address
34406 N 27TH Dr
BLDG 6, Ste 110
Phoenix, AZ 85085-6082
Phone
(602) 291-1784
NPI assigned
Jan 3, 2012
Last updated
Sep 22, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2014

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

Authorized official

Name
Michelle K Gabbert, DONPI 1295956639
Title
Member
Phone
(602) 291-1784

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
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

34406 N 27TH Dr
BLDG 6, Ste 110
Phoenix, AZ 85085-6082

Mailing address

21001 N Tatum Blvd
Ste 1630-156
Phoenix, AZ 85050-4206
Phone (602) 291-1784

Other identifiers 1

IdentifierTypeStateIssuer
670364MedicaidAZ

Other names 1

  • Desert Rose Primary Care Doing business as

National Provider Directory

National Provider Directory

Locations

21001 N Tatum Blvd
Ste 1630156
Phoenix, AZ 85050
Phone (602) 291-1784

34406 N 27th Dr
Ste 110
Phoenix, AZ 85085
Phone (623) 215-9951

Practitioners & affiliated clinicians

Practitioners 2

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": "1325548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411344000000",
    "number": "1619247939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21001 N TATUM BLVD",
            "address_2": "STE 1630-156",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850504206",
            "telephone_number": "602-291-1784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34406 N 27TH DR",
            "address_2": "BLDG 6, STE 110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850856082",
            "telephone_number": "602-291-1784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MKG INTERNAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-03",
        "last_updated": "2014-09-22",
        "status": "A",
        "authorized_official_last_name": "GABBERT",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "602-291-1784",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "670364",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Desert Rose Primary Care",
            "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 Sep 22, 2014; 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.