NPIMap

Organization Active NPI

Mariposa Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Nogales, AZ
National Provider Identifier
1013523539
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MARIPOSA COMMUNITY HEALTH CENTER, INC
Practice address
1209 W Target Range Rd
Nogales, AZ 85621-2466
Phone
(520) 287-4747
Fax
(520) 281-1112
NPI assigned
Sep 21, 2020
Last updated
Feb 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

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

Authorized official

Name
Amy Taylor
Title
Chief Executive Officer
Phone
(520) 761-2128

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

1209 W Target Range Rd
Nogales, AZ 85621-2466

Mailing address

825 N Grand Ave Ste 100
Nogales, AZ 85621-1061
Phone (520) 761-2128

Other identifiers 1

IdentifierTypeStateIssuer
091922MedicaidAZ

Other names 1

  • Mariposa Nogales West Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031226000065 AZ Part B Supplier - Clinic/Group Practice 8123926326 Receives reassigned benefits from 58 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Nogales, AZ; Tubac, AZ; Rio Rico, AZ; Patagonia, AZ
O20201204001074 AZ Part A Provider - Federally Qualified Health Center (FQHC) 8123926326 Practice locations: Nogales, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013523539. Details of each certification follow.

Federally qualified health center certification: CCN 031003

Legal name
MARIPOSA COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 30, 2020
Last certification
Nov 30, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 22, 1985 in AZ
Enrollment address
1209 W Target Range Rd
Nogales, AZ 85621-2466

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Carol M Marquez MD10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

1103 Circulo Mercado
Rio Rico, AZ 85648
Phone 5202811550 ext. 1180

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Carlos Bustamante Individual Corporate DirectorBoard Member Jun 27, 2019
Aaryn Giblin Individual Corporate DirectorBoard Member Mar 16, 2023
Ernesto Chavez Individual Corporate DirectorBoard Member Oct 7, 1998
Jennifer St. John Individual Corporate DirectorBoard Member Mar 16, 2023
Judith Claremon Individual Corporate DirectorBoard Member Jul 7, 2005
Robert Lineiro Individual Corporate DirectorBoard Member Nov 25, 1985
Chris Young Individual Corporate DirectorBoard Member Mar 17, 2022
Sandra Kory Individual Corporate DirectorBoard Member Mar 21, 2024
Lois Morris Individual Corporate DirectorBoard Member Mar 1, 2012
Lourdes Jeong Individual Corporate DirectorBoard Member Oct 11, 2001
Tia Duncan Individual Corporate OfficerChief of Administration Jun 28, 2010
W-2 Managing EmployeeChief of Administration Jun 28, 2010
Mariposa Community Health Center Inc Organization, Nogales, AZ Corporation, Non-profit Operational/Managerial Control Nov 30, 2020
Rudy Pina Individual Corporate DirectorBoard Member Feb 28, 1988
Amy Taylor Individual Corporate OfficerChief Executive Officer Nov 19, 2024
W-2 Managing EmployeeAd; Nov 27, 2023
Anthony Vartola Individual Corporate DirectorBoard Member Jun 27, 2019
John Wemlinger Individual Corporate DirectorBoard Member Sep 29, 2022

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mariposa Community Health Center IncNogales, AZ, CCN 031812 Federally qualified health center Operational/Managerial Control Oct 1, 1991
Mariposa Community Health Center IncNogales, AZ, CCN 031884 Federally qualified health center Operational/Managerial Control Jan 1, 1980
Mariposa Community Health Center IncRio Rico, AZ, CCN 031885 Federally qualified health center Operational/Managerial Control Jan 1, 2006
Family Health CenterPatagonia, AZ, CCN 031809 Federally qualified health center Operational/Managerial Control Oct 1, 1991
Mariposa Community Health Center IncTubac, AZ, CCN 031938 Federally qualified health center Operational/Managerial Control Feb 15, 2016
Maternal Child Health Center of ExcellenceNogales, AZ, CCN 031079 Federally qualified health center Operational/Managerial Control Jan 1, 1980

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 5

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": "1600646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1013523539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 N GRAND AVE STE 100",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "856211061",
            "telephone_number": "520-761-2128",
            "fax_number": "520-281-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 W TARGET RANGE RD",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "856212466",
            "telephone_number": "520-287-4747",
            "fax_number": "520-281-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIPOSA COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-21",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "520-761-2128"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091922",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mariposa Nogales West",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Mariposa Nogales West",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Nogales, AZ

Sources for this page

Verify at the official NPI Registry.