NPIMap

Organization Active NPI

Cobre Valley Regional Medical Center

Doing business as Cobre Valley Tonto Basin Clinic

  • Rural Health Clinic/Center
  • Tonto Basin, AZ
National Provider Identifier
1144799677
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COBRE VALLEY REGIONAL MEDICAL CENTER
Doing business as
Cobre Valley Tonto Basin Clinic
Practice address
186 E Stephens Way
Tonto Basin, AZ 85553
Phone
(928) 479-2871
Fax
(928) 473-3200
NPI assigned
Nov 14, 2018
Last updated
Sep 8, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
COBRE VALLEY REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

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

Authorized official

Name
Mr. Neal D Jensen
Title
Ceo
Phone
(928) 402-1122

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

186 E Stephens Way
Tonto Basin, AZ 85553

Mailing address

5880 S Hospital Dr
Globe, AZ 85501-9447
Phone (928) 425-3261

Other names 1

  • Cobre Valley Tonto Basin Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040312001228 AZ Part B Supplier - Clinic/Group Practice 0648181693 Receives reassigned benefits from 69 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Young, AZ; Tonto Basin, AZ; Kearny, AZ; Globe, AZ; Superior, AZ
O20190415002861 AZ Part A Provider - Rural Health Clinic 0648181693 Practice locations: Tonto Basin, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144799677. Details of each certification follow.

Rural health clinic certification: CCN 038513

Legal name
COBRE VALLEY REGIONAL MEDICAL CENTER
Doing business as
TONTO BASIN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 23, 2019
Last certification
Mar 5, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 29, 1988 in AZ
Enrollment address
186 E Stephens Way
Tonto Basin, AZ 85553-0239
Related CCNs
031314

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Part of
Cobre Valley Comm Hosp

Locations

5990 S Hospital Dr
Bldg D
Globe, AZ 85501

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Jack Bradford Individual Corporate DirectorVice Chairman Jun 23, 2022
Healthtech Management Services Inc Organization, Franklin, TN Management services company, Consulting firm Operational/Managerial Control Aug 18, 1992
Jody Daggett Individual Corporate DirectorChief of Medical Staff Jan 1, 2016
Edward Carpenter Individual Corporate Director Oct 24, 2006
Nick Renon Individual Corporate Director Jul 28, 2025
Paula Horn Individual Corporate DirectorSecretary Feb 22, 2024
Neal Duane Jensen Individual Corporate OfficerCeo Jul 10, 1998
Alan Osumi Individual Corporate DirectorTrustee Mar 1, 2015
Robert E Hollis Individual Corporate DirectorTreasurer Jul 20, 2014
Jendean G Sartain Individual Corporate Director Mar 1, 2005
Frank Stapleton Individual W-2 Managing EmployeeChief Clinical Operations Officer Jan 25, 2002
Fernando Shipley Individual Corporate Director Aug 1, 2004
Judy Bessee Individual Corporate DirectorChairman Feb 10, 2017

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Pleasant Valley Community Medical CenterYoung, AZ, CCN 038500 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 10, 1998

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1542153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1144799677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5880 S HOSPITAL DR",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855019447",
            "telephone_number": "928-425-3261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 E STEPHENS WAY",
            "city": "TONTO BASIN",
            "state": "AZ",
            "postal_code": "85553",
            "telephone_number": "928-479-2871",
            "fax_number": "928-473-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBRE VALLEY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COBRE VALLEY REGIONAL MEDICAL CENTER",
        "enumeration_date": "2018-11-14",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "NEAL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-402-1122",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cobre Valley Tonto Basin Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cobre Valley Tonto Basin Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tonto Basin, AZ

Sources for this page

Verify at the official NPI Registry.