NPIMap

Organization Active NPI

Community Intervention Associates

Doing business as Community Health Associates

  • Community/Behavioral Health Agency
  • Nogales, AZ
National Provider Identifier
1043504376
Registry record updated Feb 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
BH-3771 Issued in AZ
Legal business name
COMMUNITY INTERVENTION ASSOCIATES
Doing business as
Community Health Associates
Practice address
32 Blvd del Rey David
Nogales, AZ 85621
Phone
(520) 394-7400
Fax
(520) 377-9596
NPI assigned
Jun 3, 2011
Last updated
Feb 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2016

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

Authorized official

Name
Mr. Fred R Cogburn
Title
Ceo
Phone
(928) 376-0026

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X B-3771 AZ
Community/Behavioral Health Agency 251S00000X BH-3771 AZ Primary

Addresses

Primary practice location

32 Blvd del Rey David
Nogales, AZ 85621

Mailing address

2851 S Ave B
BLDG 4
Yuma, AZ 85364-7726
Phone (928) 376-0026

Other identifiers 1

IdentifierTypeStateIssuer
603657MedicaidAZ

Other names 1

  • Community Health Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120201000213 AZ Part B Supplier - Clinic/Group Practice 4880851971 Receives reassigned benefits from 34 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Yuma, AZ; Tucson, AZ; San Luis, AZ; Parker, AZ; Nogales, AZ; Green Valley, AZ; Douglas, AZ; Casa Grande, AZ…

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Cha19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

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": "1307059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455235200000",
    "number": "1043504376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2851 S AVE B",
            "address_2": "BLDG 4",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853647726",
            "telephone_number": "928-376-0026",
            "fax_number": "928-782-2298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 BLVD DEL REY DAVID",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "85621",
            "telephone_number": "520-394-7400",
            "fax_number": "520-377-9596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY INTERVENTION ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-03",
        "last_updated": "2016-02-12",
        "status": "A",
        "authorized_official_last_name": "COGBURN",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-376-0026",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "B-3771",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "BH-3771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "603657",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nogales, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.