Organization Active NPI

Gilbert Primary Care PC

  • Internal Medicine Physician
  • Mesa, AZ
National Provider Identifier
1720153810
Registry record updated Apr 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GILBERT PRIMARY CARE PC
Doing business as
Gilbert Primary Care PC
Practice address
3048 E Baseline Rd
Suite 120
Mesa, AZ 85204
Phone
(480) 505-3292
Fax
(480) 505-3288
NPI assigned
Nov 22, 2006
Last updated
Apr 2, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2013

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

Authorized official

Name
Rene De Jesus
Title
Controller
Phone
(480) 505-3292

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X AZ
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X AZ
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

3048 E Baseline Rd
Suite 120
Mesa, AZ 85204

Mailing address

3048 E Baseline Rd
Suite 120
Mesa, AZ 85204
Phone (480) 505-3292

Other names 1

  • Gilbert Primary Care PC Doing business as

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
03D0980440Optum Primary Care-Gilbert Baseline3048 E Baseline Rd, #120, Mesa, AZ 85204Certificate of waiverNov 20, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364860800000",
    "number": "1720153810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3048 E BASELINE RD",
            "address_2": "SUITE 120",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85204",
            "telephone_number": "480-505-3292",
            "fax_number": "480-505-3288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3048 E BASELINE RD",
            "address_2": "SUITE 120",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85204",
            "telephone_number": "480-505-3292",
            "fax_number": "480-505-3288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILBERT PRIMARY CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2013-04-02",
        "status": "A",
        "authorized_official_last_name": "DE JESUS",
        "authorized_official_first_name": "RENE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "480-505-3292"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gilbert Primary Care PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2013; 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.