Chiricahua Community Health Centers, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Bisbee, AZ
NPI 1063540144 · NPPES record last updated Sep 1, 2021
Key facts
- NPI
- 1063540144
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- OTC3370 (AZ)
- Legal business name
- CHIRICAHUA COMMUNITY HEALTH CENTERS, INC
- Practice address
- 108 Arizona St
Bisbee, AZ 85603-1804 - Phone
- (520) 432-3309
- Fax
- (520) 364-4261
- NPI assigned
- Mar 1, 2007
- Organization subpart
- No
Authorized official
- Name
- Jonathan P Melk
- Title
- Ceo
- Phone
- (520) 364-1429
Owners & managing parties with NPI records 2
-
Daniel Abram Driscoll, MD/PHD
-
Jonathan Paul Melk, M.D.
Other NPIs on the same Medicare enrollment 14
Other NPIs with the same Medicare PAC ID 15
Corporate family (same tax ID) 21
Practitioners 48
-
Darlene R. Melk, MD
-
Jazmine Aglae Morales, LMSW
-
Victoria L Ochoa, FNP
-
Jennifer Hale Smith, M.D.
-
Dawn Azbill, FNP-C
-
Samantha Kalyani Bassett, FNP-C
-
Jessica Lynn Crewse, FNP
-
Gustavo Durazo Jr., DNP
-
Elizabeth Fabry, ANP
-
Jamie Lynn Fitzpatrick, APRN-RNP
-
Elizabeth Grijalva, APRN-CNP
-
Kerstin P Hurley, PHD
-
Clinton Lavar Huston, D.C.
-
Joshua Jean, MD
-
Olivia Nicole Johnson, BSN, RN
-
Tonya Lee Johnson, FNP-C
-
Heather L Kinder, RN IBCLC
-
Polly Paccassi Lund, MSW, CSW-I
-
Dia Cherie Madden, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D1012127 | Bisbee Family Health Center | Certificate of waiver | May 31, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ
Federally qualified health center certification: CCN 031963
- Legal name
- CHIRICAHUA COMMUNITY HEALTH CENTERS INC
- Doing business as
- BISBEE FAMILY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 20, 2017
- Last certification
- Nov 20, 2017
- Ownership / control type
- Non-profit – church related
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 6, 1995 in AZ
- Enrollment address
- 108 Arizona St
Bisbee, AZ 85603-1804
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Demetry Simonton |
Corporate Director |
Jan 11, 2025 | |
| Daniel a Driscoll |
Corporate Officer |
Jan 1, 2023 | |
| W-2 Managing Employee |
Jan 1, 2023 | ||
| Alvaro Montoya |
Corporate Director |
Jun 25, 2019 | |
| Britt Hanson |
Corporate Director |
Aug 20, 2022 | |
| Jonathan P Melk |
Corporate Officer |
Oct 8, 2018 | |
| W-2 Managing Employee |
Oct 8, 2018 | ||
| George Cullinan |
Corporate Director |
Jul 2, 2018 | |
| Amy Haritatos |
Corporate Director |
Oct 17, 2022 | |
| Tamra Venice Springer |
Corporate Officer | Jan 9, 2023 | |
| Corporate Director | Jan 9, 2023 | ||
| W-2 Managing Employee | Jan 9, 2023 | ||
| Carrie Gustavson |
Corporate Officer |
Oct 8, 2018 | |
| Corporate Director |
Oct 8, 2018 | ||
| Karl Griffor |
Corporate Director |
Dec 3, 2024 | |
| Alma Vildosola |
Corporate Director |
Jul 2, 2018 | |
| Caleb Blaschke |
Corporate Director |
Jan 11, 2025 | |
| Lawerence Sanders |
Corporate Director |
Jan 11, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040206000860 | AZ | Part B Supplier - Clinic/Group Practice | 5395638878 |
Receives reassigned benefits from 59 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bisbee, AZ; Willcox, AZ; Sierra Vista, AZ; Douglas, AZ; Elfrida, AZ; Benson, AZ |
| O20171206001975 | AZ | Part a Provider - Federally Qualified Health Center (FQHC) | 5395638878 |
1 other NPI on this enrollment Practice locations: Bisbee, AZ |
National Provider Directory
- Tax ID family
- Chiricahua Community Health
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | OTC3370 | AZ | Yes |
Addresses
Primary practice location
108 Arizona St
Bisbee, AZ 85603-1804
Mailing address
1205 F Avenue
Douglas, AZ 85607
Phone (520) 364-1429
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 945154 | Medicaid | AZ |
Other names
- Chiricahua Community Health Centers, INC-Bisbee Clinic
Other providers in Bisbee, AZ
- Julia M Brown
- Ernestina S Buck
- Shadd Nathan Cabalatungan
- Phyllis Cavanaugh
- Nicole M. Chavez
- Chiricahua Community Health Centers, Inc
- Chiricahua Community Health Centers, Inc.
- City of Bisbee
- City of Bisbee Ambulance
- Cochise County
All providers in Bisbee, AZ · Federally Qualified Health Center (FQHC) in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2021. 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.