NPIMap

Organization Active NPI

San Luis Walk-in Clinic, Inc.

  • Rural Health Clinic/Center
  • Somerton, AZ
National Provider Identifier
1003991506
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAN LUIS WALK-IN CLINIC, INC.
Practice address
950 E Main St BLDG B
Somerton, AZ 85350-7409
Phone
(928) 236-8001
Fax
(928) 722-6113
NPI assigned
Oct 25, 2006
Last updated
Sep 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SAN LUIS WALK-IN CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Authorized official

Name
Mrs. Amanda AguirreNPI 1942615760
Title
President & Ceo
Phone
(928) 315-7910

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
Multi-Specialty Clinic/Center 261QM1300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

950 E Main St BLDG B
Somerton, AZ 85350-7409

Mailing address

PO Box 617
Somerton, AZ 85350-0617
Phone (928) 315-7910

Other practice location 1

214 W Main St
Somerton, AZ 85350-6329
Phone (928) 627-1120

Other practice location 2

1896 E Babbit Ln
San Luis, AZ 85336-7820
Phone (928) 722-6112

Other practice location 3

601 W Riverside Dr Ste 4
Parker, AZ 85344-5119
Phone (928) 256-4110

Other practice location 4

601 W Riverside Dr Ste 2
Parker, AZ 85344-5119
Phone (928) 256-4110

Other identifiers 1

IdentifierTypeStateIssuer
836512MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ8 enrollments

Enrollment records 8

Enrollment IDStateProvider typePAC IDDetails
O20040315000556 AZ Part A Provider - Rural Health Clinic 2668361841 1 other NPI on this enrollment
Practice locations: San Luis, AZ
O20040514000795 AZ Part B Supplier - Clinic/Group Practice 2668361841 Receives reassigned benefits from 88 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Somerton, AZ; Yuma, AZ; San Luis, AZ; Kingman, AZ; Parker, AZ; Lake Havasu City, AZ
O20200505001943 AZ Part A Provider - Rural Health Clinic 2668361841 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Parker, AZ
O20200511002274 AZ Part A Provider - Rural Health Clinic 2668361841 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Parker, AZ
O20210309003076 AZ Part A Provider - Rural Health Clinic 2668361841 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Luis, AZ
O20210311001299 AZ Part B Supplier - Ambulatory Surgical Center 2668361841 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Luis, AZ
O20210316000496 AZ Part A Provider - Rural Health Clinic 2668361841 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Luis, AZ
O20210316001228 AZ Part A Provider - Rural Health Clinic 2668361841 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Luis, AZ

NPI to CCN mapping 6

The Medicare certification numbers (CCNs) connected to NPI 1003991506. Details of each certification follow.

Rural health clinic certification: CCN 033831

Legal name
SAN LUIS WALK-IN CLINIC INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 25, 2004
Last certification
Jul 12, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 1, 2003 in AZ
Enrollment address
1896 E Babbit LN
San Luis, AZ 85336-7820

Rural health clinic certification: CCN 033843

Legal name
SAN LUIS WALK-IN CLINIC INC
Doing business as
PARKER WALK IN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 26, 2020
Last certification
Sep 1, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 2020 in AZ
Enrollment address
601 W Riverside Dr
Ste 2
Parker, AZ 85344

Rural health clinic certification: CCN 033842

Legal name
SAN LUIS WALK-IN CLINIC INC
Doing business as
PARKER WALK IN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 4, 2020
Last certification
Jul 25, 2023
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 2020 in AZ
Enrollment address
601 W Riverside Dr
Ste 4
Parker, AZ 85344

Rural health clinic certification: CCN 033847

Legal name
SAN LUIS WALK-IN CLINIC INC
Doing business as
WOMEN'S HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 9, 2021
Last certification
Jun 11, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
151 S Oak Ave
Ste 3
San Luis, AZ 85336-0756

Rural health clinic certification: CCN 033850

Legal name
SAN LUIS WALK-IN CLINIC INC
Doing business as
SPECIALTY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 21, 2022
Last certification
Oct 21, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
151 S Oak Ave
Ste 5
San Luis, AZ 85336-0756

Rural health clinic certification: CCN 033845

Legal name
SAN LUIS WALK-IN CLINIC INC
Doing business as
SAN LUIS URGENT CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 9, 2021
Last certification
Jun 12, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
151 S Oak Ave
Ste 7
San Luis, AZ 85336-0756

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 21

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 21

National Provider Directory

National Provider Directory
Part of
San Luis Walk-in Clinic Inc

Locations

3003 Highway 95
Bullhead City, AZ 86442
Phone (928) 763-8750

2302 N Stockton Hill Rd
Ste G
Kingman, AZ 86401
Phone (928) 718-2225

601 W Riverside Dr
Ste 4
Parker, AZ 85344
Phone (928) 256-4110

950 E Main St
Somerton, AZ 85350
Phone (928) 315-7910

950 E Main St
Bldg C
Somerton, AZ 85350
Phone (928) 324-1040

2175 S Avenue A
Ste A
Yuma, AZ 85364
Phone (928) 315-7910

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Howie Jorajuria Individual Corporate DirectorBoard Member Jan 27, 2019
Corporate DirectorBoard Member Apr 1, 2020
Corporate DirectorBoard Member Feb 1, 2020
Corporate DirectorAssistant Secretary Mar 1, 2021
Candice L Orduno Individual Corporate DirectorBoard Member Feb 6, 2009
Corporate DirectorBoard Member Apr 1, 2020
Corporate DirectorBoard Member Feb 1, 2020
Corporate DirectorChair Mar 1, 2021
San Luis Walk-in Clinic Inc Organization, Somerton, AZ Holding company Operational/Managerial Control May 1, 2003 100%
Gertrudis Medina Individual Corporate DirectorBoard Member Jan 27, 2019
Corporate DirectorSecretary Mar 1, 2021
Elizabeth Carpenter Individual OtherTreasurer/Secretary May 26, 2022
Corporate DirectorBoard Member May 26, 2022
Amanda Aguirre Individual Corporate OfficerPresident and Ceo May 1, 2003
Operational/Managerial ControlPresident and Ceo May 1, 2003
Corporate OfficerPresident & Ceo Apr 1, 2020
Corporate OfficerPresident & Ceo Feb 1, 2020
Corporate OfficerPresident & Ceo Mar 1, 2021
Victor Lozano Individual Corporate DirectorBoard Member Jan 27, 2011
Corporate DirectorBoard Member Apr 1, 2020
Corporate DirectorBoard Member Feb 1, 2020
Corporate DirectorBoard Member Mar 1, 2021
Jason Bradley Individual Corporate DirectorBoard Member Apr 25, 2019
Corporate DirectorBoard Member Apr 1, 2020
Corporate DirectorBoard Member Feb 1, 2020
Corporate DirectorBoard Member Mar 1, 2021
Marisol Penuelas Individual W-2 Managing EmployeeClinical Operations Director Jun 22, 2022
Corporate DirectorClinical Operations Director Jun 22, 2022
W-2 Managing EmployeeAd; Jun 22, 2022
W-2 Managing Employee Jun 22, 2022
Corporate OfficerChief Officer of Quality/Med Inform Jun 22, 2022
Operational/Managerial ControlChief Officer of Quality/Med Inform Jun 22, 2023
Juan M Guerrero Individual Corporate DirectorBoard Member Feb 24, 2016
Corporate DirectorBoard Member Apr 1, 2020
Corporate DirectorBoard Member Feb 1, 2020
Corporate DirectorVice Chair Mar 1, 2021
Ryan Holt Individual OtherVice Chair Sep 30, 2021
Corporate DirectorBoard Member Sep 30, 2021
Eraclio Arvizu Individual Corporate DirectorVice Chair Jan 27, 2019
Corporate DirectorBoard Member Apr 1, 2020
Corporate DirectorBoard Member Feb 1, 2020
Corporate DirectorBoard Member Mar 1, 2021
Ron Clark Individual Corporate DirectorBoard Member Dec 19, 2024
Augustus Matthew Kurupas Individual Corporate DirectorBoard Member Sep 19, 2024
Arturo Magana Individual Corporate DirectorTreasurer Mar 1, 2021
Maria Elena Rodriguez Individual Corporate OfficerClinical Operating Officer Apr 26, 2006
W-2 Managing EmployeeClinical Operating Officer Apr 26, 2006
Christopher Nunez Individual Corporate DirectorBoard Member Mar 1, 2021

Owners & managing parties with NPI records 13

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 13

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 260

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 260

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1003991506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 617",
            "city": "SOMERTON",
            "state": "AZ",
            "postal_code": "853500617",
            "telephone_number": "928-315-7910",
            "fax_number": "928-722-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 E MAIN ST BLDG B",
            "city": "SOMERTON",
            "state": "AZ",
            "postal_code": "853507409",
            "telephone_number": "928-236-8001",
            "fax_number": "928-722-6113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "214 W Main St",
            "address_purpose": "LOCATION",
            "city": "Somerton",
            "state": "AZ",
            "postal_code": "853506329",
            "country_code": "US",
            "telephone_number": "928-627-1120",
            "fax_number": "928-722-6113",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1896 E Babbit Ln",
            "address_purpose": "LOCATION",
            "city": "San Luis",
            "state": "AZ",
            "postal_code": "853367820",
            "country_code": "US",
            "telephone_number": "928-722-6112",
            "fax_number": "928-722-6113",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 W Riverside Dr Ste 4",
            "address_purpose": "LOCATION",
            "city": "Parker",
            "state": "AZ",
            "postal_code": "853445119",
            "country_code": "US",
            "telephone_number": "928-256-4110",
            "fax_number": "928-256-4112",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 W Riverside Dr Ste 2",
            "address_purpose": "LOCATION",
            "city": "Parker",
            "state": "AZ",
            "postal_code": "853445119",
            "country_code": "US",
            "telephone_number": "928-256-4110",
            "fax_number": "928-256-4112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAN LUIS WALK-IN CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN LUIS WALK-IN CLINIC, INC.",
        "enumeration_date": "2006-10-25",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "AGUIRRE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "928-315-7910",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "836512",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerton, AZ

Sources for this page

Verify at the official NPI Registry.