NPIMap

Organization Active NPI

Northern Cochise Community Hospital Inc

  • Critical Access Hospital
  • Willcox, AZ
National Provider Identifier
1013060367
Registry record updated Oct 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
RGH-0128 Issued in 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
Last updated
Oct 11, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2016

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

Authorized official

Name
Mr. Roland Knox
Title
Ceo
Phone
(520) 384-3541

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X RGH-0128 AZ Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 4

The Medicare certification numbers (CCNs) connected to NPI 1013060367. Details of each certification follow.

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
CorporationNon-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
CorporationNon-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
CorporationNon-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
CorporationNon-profit
Incorporated
May 19, 1966 in AZ
Enrollment address
901 W Rex Allen Dr
Willcox, AZ 85643-1009
Other Hospital Practice Location

Care Compare: Hospital

Medicare Care Compare
Listed as
Northern Cochise Community Hospital, Inc.CCN 031302 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Northern Cochise Comm Hosp5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

709 Mall Blvd
Savannah, GA 31406
Phone (912) 201-8000

4646 John R St
Detroit, MI 48201
Phone (313) 576-3389

16525 Fort St
Southgate, MI 48195
Phone (734) 250-9529

3200 La Orilla Rd NW
Ste D3
Albuquerque, NM 87120
Phone (505) 873-2064

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Jay a Katz Individual Corporate DirectorBoard Member Jun 1, 2021
Daniel Wilson Individual Corporate Director Jun 14, 2023
Corporate Director Jun 1, 2023
Corporate Director Jan 15, 2019
Julia Strange Individual Corporate DirectorBoard Member Jun 1, 2021
Carol Dunagan Individual Corporate Director Jun 1, 2023
Gary Kartchner Individual Corporate Officer Nov 30, 2024
W-2 Managing Employee Nov 30, 2024
Northern Cochise Community Hospital Inc Organization, Willcox, AZ Non-profit 5% Or Greater Direct Ownership Interest Mar 2, 2002
James Kraykovich Individual W-2 Managing Employee Nov 1, 2024
Kimberly Aguirre Individual W-2 Managing Employee Jul 1, 2014

Practitioners & affiliated clinicians

Practitioners 102

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 102

Affiliated clinicians 106

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 106

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476144000000",
    "number": "1013060367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 W REX ALLEN DR",
            "city": "WILLCOX",
            "state": "AZ",
            "postal_code": "856431009",
            "telephone_number": "520-384-3541",
            "fax_number": "520-384-0734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W REX ALLEN DR",
            "city": "WILLCOX",
            "state": "AZ",
            "postal_code": "856431009",
            "telephone_number": "520-384-3541",
            "fax_number": "520-384-0734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN COCHISE COMMUNITY HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2016-10-11",
        "status": "A",
        "authorized_official_last_name": "KNOX",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-384-3541",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "AZ",
            "license": "RGH-0128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willcox, AZ

Sources for this page

Verify at the official NPI Registry.