NPIMap

Organization Active NPI

Summit Healthcare Medical Associates

  • Rural Health Clinic/Center
  • Eagar, AZ
National Provider Identifier
1063166999
Registry record updated Feb 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SUMMIT HEALTHCARE MEDICAL ASSOCIATES
Practice address
606 N Main St
Eagar, AZ 85925-9813
Phone
(928) 333-5333
Fax
(928) 333-5100
NPI assigned
Feb 9, 2022
Last updated
Feb 9, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
SUMMIT HEALTHCARE ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 9, 2022

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

Authorized official

Name
Kenneth Robert Allen
Title
Chief Practice Officer
Phone
(928) 537-4375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

606 N Main St
Eagar, AZ 85925-9813

Mailing address

2200 E Show Low Lake Rd
Show Low, AZ 85901-7831
Phone (928) 537-6393

Other names 1

  • Summit Healthcare Family Medicine Eagar Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140815000931 AZ Part B Supplier - Clinic/Group Practice 8729205737 Receives reassigned benefits from 116 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Overgaard, AZ; St Johns, AZ; Snowflake, AZ; Show Low, AZ; Holbrook, AZ; Eagar, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063166999. Details of each certification follow.

Rural health clinic certification: CCN 033851

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SUMMIT HEALTHCARE FAMILY MEDICINE EAGAR
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 20, 2022
Last certification
Oct 20, 2022
Ownership / control type
1B
Facility address
606 North Main Street
Eagar, AZ 85925

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
Part of
Summit Healthcare Assoc

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

100 E Code Talkers Dr
Holbrook, AZ 86025
Phone (928) 524-3751

2051 Evergreen Ln
Ste Bc
Show Low, AZ 85901
Phone (928) 537-6977

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 103

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 103

NPI Registry JSON

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

{
    "created_epoch": "1644364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644364800000",
    "number": "1063166999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 E SHOW LOW LAKE RD",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859017831",
            "telephone_number": "928-537-6393",
            "fax_number": "928-532-2131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 N MAIN ST",
            "city": "EAGAR",
            "state": "AZ",
            "postal_code": "859259813",
            "telephone_number": "928-333-5333",
            "fax_number": "928-333-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT HEALTHCARE MEDICAL ASSOCIATES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMMIT HEALTHCARE ASSOCIATION",
        "enumeration_date": "2022-02-09",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF PRACTICE OFFICER",
        "authorized_official_telephone_number": "928-537-4375"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Healthcare Family Medicine Eagar",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Eagar, AZ

Sources for this page

Verify at the official NPI Registry.