NPIMap

Organization Active NPI

Nevada Health Centers Inc

Doing business as Elko Family Medical and Dental Center

  • Federally Qualified Health Center (FQHC)
  • Elko, NV
National Provider Identifier
1073690616
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEVADA HEALTH CENTERS INC
Doing business as
Elko Family Medical and Dental Center
Practice address
762 14TH St
Elko, NV 89801-3413
Phone
(775) 738-1553
Fax
(775) 738-5856
NPI assigned
Nov 1, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
NEVADA HEALTH CENTERS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Walter B Davis
Title
Ceo
Phone
(775) 888-6610

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NV Primary

Addresses

Primary practice location

762 14TH St
Elko, NV 89801-3413

Mailing address

3325 Research Way
Carson City, NV 89706-7913
Phone (775) 888-6610

Other identifiers 2

IdentifierTypeStateIssuer
1073690616MedicaidNV
DQ468COtherNVMEDICARE ID - TYPE UNSPECIFIED

Other names 1

  • Elko Family Medical and Dental Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000452 NV Part B Supplier - Clinic/Group Practice 7113835307 Receives reassigned benefits from 65 practitioners
34 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Las Vegas, NV; North Las Vegas, NV; Pahrump, NV; Reno, NV; Virginia City, NV; West Wendover, NV; Amargosa Valley, NV; Austin, NV…
O20100727000201 NV Part A Provider - Federally Qualified Health Center (FQHC) 7113835307 Practice locations: Elko, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073690616. Details of each certification follow.

Federally qualified health center certification: CCN 291833

Legal name
NEVADA HEALTH CENTERS INC
Doing business as
ELKO FAMILY MEDICAL & DENTAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 12, 2005
Last certification
Jul 12, 2005
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 22, 1992 in NV
Enrollment address
762 14TH St
Elko, NV 89801-3413
Related CCNs
291801

Other NPIs with the same Medicare PAC ID 24

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

View all 24

Other NPIs on the same Medicare enrollment 34

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

View all 34

National Provider Directory

National Provider Directory
Tax ID family
Fernley Family Medical34 organizations share this tax ID, including this one
Part of
Fernley Family Medical

Other organizations with this tax ID 33

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

View all 33

Locations

845 E Farm Rd
Amargosa Vly, NV 89020
Phone (775) 372-5432

3325 Research Way
Fl 2
Carson City, NV 89706

1450 S Main St
Las Vegas, NV 89104

823 Las Vegas Blvd S
Ste 500
Las Vegas, NV 89101
Phone (702) 469-0341

8440 S Eastern Ave
Ste A
Las Vegas, NV 89123
Phone (702) 269-0204

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Paula C Moore Individual Corporate DirectorBoard Member May 1, 2025
Wendy Charlebois Individual Corporate DirectorBoard Member May 1, 2025
Timothy Blakely Individual Corporate DirectorBoard Member Jun 1, 2018
Lyn Beggs Individual Corporate DirectorSecretary Jun 1, 2022
Jeff Snyder Individual Corporate DirectorBoard Member Jun 1, 2016
Tom Zumtobel Individual Corporate DirectorVice Chair Jun 1, 2022
Linda Bingaman Individual Corporate DirectorTreasurer May 15, 2015
Kathryn L Triplett Individual Corporate OfficerChief Financial Officer Oct 1, 2016 100%
W-2 Managing EmployeeChief Financial Officer Oct 1, 2016 100%
Maurice Washington Individual Corporate DirectorChairman May 15, 2015
Nicola Aaker Individual Corporate DirectorBoard Member May 1, 2025
Richard Luman Individual Corporate DirectorBoard Member May 1, 2025
Elizabeth Esteves Individual W-2 Managing EmployeeProvider Relations Manager Jun 10, 2024
Lisbeth Soriano Individual Corporate DirectorBoard Member May 1, 2025
Walter B Davis Individual Corporate OfficerCeo Nov 26, 2012 100%
W-2 Managing EmployeeCeo Nov 26, 2012 100%

All facility ownership & control disclosures 14

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

FacilityTypeRoleSince
Cambridge Family Health CenterLas Vegas, NV, CCN 291829 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2013
North Las Vegas Family Health CenterNorth Las Vegas, NV, CCN 291824 Federally qualified health center Operational/Managerial Control (100%) May 3, 2013
Eastern Family Medical and Dental CenterLas Vegas, NV, CCN 291837 Federally qualified health center Operational/Managerial Control (100%) Jun 29, 2010
Jackpot Community Health CenterJackpot, NV, CCN 291823 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 1999
Henderson Family Health CenterHenderson, NV, CCN 291849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 18, 2015
Nevada Health Centers Carson City School BasedCarson City, NV, CCN 291854 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 21, 2015
Nevada Health Centers at Virginia CityVirginia City, NV, CCN 291855 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 29, 2015
Nevada Children's Health ProjectLas Vegas, NV, CCN 291862 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 26, 2018
Nevada Health Centers at EnterpriseLas Vegas, NV, CCN 291863 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 10, 2019
Willow Street Health CenterReno, NV, CCN 291009 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 22, 2023
Mobile Medical Services 1Carson City, NV, CCN 291010 Federally qualified health center 5% Or Greater Direct Ownership Interest Dec 29, 2023
Mobile Dental Services 1Elko, NV, CCN 291011 Federally qualified health center 5% Or Greater Indirect Ownership Interest Dec 1, 2023
Nellis Family Medical & Dental CenterLas Vegas, NV, CCN 291013 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 9, 2024
Pahrump Family Health CenterPahrump, NV, CCN 291014 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 8, 2024

Owned or controlled facilities with NPI records 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1073690616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 RESEARCH WAY",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897067913",
            "telephone_number": "775-888-6610",
            "fax_number": "775-888-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "762 14TH ST",
            "city": "ELKO",
            "state": "NV",
            "postal_code": "898013413",
            "telephone_number": "775-738-1553",
            "fax_number": "775-738-5856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEVADA HEALTH CENTERS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEVADA HEALTH CENTERS INC",
        "enumeration_date": "2006-11-01",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "775-888-6610"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073690616",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID - TYPE UNSPECIFIED",
            "identifier": "DQ468C",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elko Family Medical and Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elko, NV

Sources for this page

Verify at the official NPI Registry.