Northern Cochise Community Hospital Inc
Organization Active NPI Critical Access Hospital · Willcox, AZ
NPI 1013060367 · NPPES record last updated Oct 11, 2016
Key facts
- NPI
- 1013060367
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- RGH-0128 (AZ)
- Legal business name
- NORTHERN COCHISE COMMUNITY HOSPITAL INC
- Practice address
- 901 W Rex Allen Dr
Willcox, AZ 85643-1009 - Phone
- (520) 384-3541
- Fax
- (520) 384-0734
- NPI assigned
- Jan 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Roland Knox
- Title
- Ceo
- Phone
- (520) 384-3541
Corporate family (same tax ID) 4
Practitioners 103
-
Trevor Alan Jones, FNP-C
-
Laurel Susan Kibler, FNP
-
Christopher Earl Spooner, M.D.
-
Donald Michael Anzalone, AGACNP-BC
-
Jeffery Burl Bushman, D.O.
-
Thomas R. Cain, M.D.
-
Robert Duran, M.D.
-
Daniel Rawn Emig, M.D.
-
John T James, D.O.
-
Kevin Arthur Kearney, M.D.
-
Paul Lampert, M.D.
-
Mark Estes Luce, MD
-
Kalpesh C Patel, MD
-
Anjali Roy, MD
-
Barry Sadegi, M.D.
-
Ajai K Sawhney, MD
-
Ezra Richard Singer, M.D.
-
Basel Skeif, M.D.
-
Doris R Stair, M.D.
Affiliated clinicians 106
-
Kristian Victoria Abarca, DNP, FNP
-
Ubair Ahmed, M.D.
-
Gaurav Anand, MD
-
Catherine A Azar, MD
-
Ryan D. Beckett, M.D.
-
William Bryson Bendall, M.D.
-
Amanda Dawn Bennett, FNP-C
-
William G Berger, MD
-
Adam Bevevino, M.D.
-
Kevin Bolanos, DO
-
Rex D. Bryce, M.D.
-
Jenna Bumgardner, PA
-
David Joseph Byron, M.D.
-
Thomas R. Cain, M.D.
-
Shalini Chabra, M.D.
Medicare Care Compare: Hospital
- Listed as
- Northern Cochise Community Hospital, Inc.
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (5 enrollments) in AZ
Hospital certification: CCN 031302
- Legal name
- NORTHERN COCHISE COMMUNITY HOSPITAL INC
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Feb 1, 2002
- Last certification
- Jul 10, 2024
- Beds
- 24
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 19, 1966 in AZ
- Enrollment address
- 901 W Rex Allen Dr
Willcox, AZ 85643-1009
Rural health clinic certification: CCN 033992
- Legal name
- NORTHERN COCHISE COMMUNITY HOSPITAL INC
- Doing business as
- SULPHUR SPRINGS MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Sep 27, 2004
- Last certification
- Jul 10, 2024
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 19, 1966 in AZ
- Enrollment address
- 900 W Scott St
Willcox, AZ 85643-1017 - Related CCNs
- 031302
Rural health clinic certification: CCN 033989
- Legal name
- NORTHERN COCHISE COMMUNITY HOSPITAL INC
- Doing business as
- SUNSITES MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Sep 28, 2004
- Last certification
- Jun 21, 2023
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 19, 1966 in AZ
- Enrollment address
- 223 N Frontage Rd
Pearce, AZ 85625-0186 - Related CCNs
- 031302
Hospital certification: CCN 03Z302
- Legal name
- NORTHERN COCHISE COMMUNITY HOSPITAL INC
- Doing business as
- NORTHERN COCHISE COMMUNITY HOSPITAL
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 19, 1966 in AZ
- Enrollment address
- 901 W Rex Allen Dr
Willcox, AZ 85643-1009
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Jay a Katz |
Corporate Director |
Jun 1, 2021 | |
| Daniel Wilson |
Corporate Director | Jun 14, 2023 | |
| Corporate Director | Jun 1, 2023 | ||
| Corporate Director | Jan 15, 2019 | ||
| Julia Strange |
Corporate Director |
Jun 1, 2021 | |
| Carol Dunagan |
Corporate Director | Jun 1, 2023 | |
| Gary Kartchner |
Corporate Officer | Nov 30, 2024 | |
| W-2 Managing Employee | Nov 30, 2024 | ||
| Northern Cochise Community Hospital Inc |
5% Or Greater Direct Ownership Interest | Mar 2, 2002 | |
| James Kraykovich |
W-2 Managing Employee | Nov 1, 2024 | |
| Kimberly Aguirre |
W-2 Managing Employee | Jul 1, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030603000033 | AZ | Part a Provider - Critical Access Hospital | 4981514288 |
Receives reassigned benefits from 15 practitioners Practice locations: Willcox, AZ |
| O20040528000972 | AZ | Part a Provider - Rural Health Clinic | 4981514288 | Practice locations: Willcox, AZ |
| O20040528001071 | AZ | Part a Provider - Rural Health Clinic | 4981514288 | Practice locations: Pearce, AZ |
| O20040727001399 | AZ | Part B Supplier - Clinic/Group Practice | 4981514288 |
Receives reassigned benefits from 42 practitioners Practice locations: Willcox, AZ |
| O20071018000856 | AZ | Part a Provider - Critical Access Hospital | 4981514288 |
Receives reassigned benefits from 1 practitioner Practice locations: Willcox, AZ |
National Provider Directory
- Tax ID family
- Northern Cochise Commun
Locations
1930 S Alma School Rd
Ste A103
Mesa, AZ 85210
Phone (866) 270-0356
1300 S 20th Ave
Safford, AZ 85546
Phone (928) 428-3122
3945 E Paradise Falls Dr
Ste 201
Tucson, AZ 85712
Phone (520) 290-5888
524 W Maley Pl
Willcox, AZ 85643
Phone (520) 384-2252
709 Mall Blvd
Savannah, GA 31406
Phone (912) 201-8000
303 E Kearsley St
Flint, MI 48502
Phone (810) 762-3147
Central Michigan University
Mount Pleasant, MI 48859
Phone (216) 513-5133
16525 Fort St
Southgate, MI 48195
Phone (734) 250-9529
900 Oakwood St
Ypsilanti, MI 48197
Phone (248) 760-8242
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | RGH-0128 | AZ | Yes |
Addresses
Primary practice location
901 W Rex Allen Dr
Willcox, AZ 85643-1009
Mailing address
901 W Rex Allen Dr
Willcox, AZ 85643-1009
Phone (520) 384-3541
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020058 | Medicaid | AZ |
Other providers in Willcox, AZ
- Darci McInnes
- Mark A. McManigle
- Ronald J Nelson
- Brad Nielson
- Northern Cochise Community Hospital
- Northern Cochise Community Hospital Inc
- Northern Cochise Community Hospital Inc
- Bruce A Ogg
- Peter Orzech
- Alma Christina Pando
All providers in Willcox, AZ · Critical Access Hospital in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.