Cobre Valley Regional Medical Center
Organization Active NPI Rural Health Clinic/Center · Tonto Basin, AZ
NPI 1144799677 · NPPES record last updated Sep 8, 2022
Key facts
- NPI
- 1144799677
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- COBRE VALLEY REGIONAL MEDICAL CENTER
- Practice address
- 186 E Stephens Way
Tonto Basin, AZ 85553 - Phone
- (928) 479-2871
- Fax
- (928) 473-3200
- NPI assigned
- Nov 14, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- COBRE VALLEY REGIONAL MEDICAL CENTER
Authorized official
- Name
- Mr. Neal D Jensen
- Title
- Ceo
- Phone
- (928) 402-1122
Owners & managing parties with NPI records 2
-
Alan K. Osumi, MD
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 8
Related certifications (CCN) 3
Facilities with the same owner 7
Practitioners 46
-
Zachariah McBride, PA-C
-
Thomas H Sanford, MD
-
Steven Sckolnik, MD
-
Rachel Alt, MD
-
Cyrus C Bowers, D.O.
-
Douglas J Campbell, M.D.
-
Tanner Bo Carlson, PA-C
-
Scott T. Croft, M.D.
-
Fernando Cruzado, MD
-
Mark Ellis, DPM
-
Margo Ruth Flores, NP-C
-
Evan Franke, M.D.
-
Karen M Gremminger, M.D.
-
Blaine S. Jensen, PA-C
-
Patrick Law, DPM
-
Tyler Peery, FNP
-
Micah David Pullins, D.O.
-
Peter R Seipel, MD
-
Abhishiek Sharma, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ
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
- Corporation · Non-profit
- Incorporated
- Mar 29, 1988 in AZ
- Enrollment address
- 186 E Stephens Way
Tonto Basin, AZ 85553-0239 - Related CCNs
- 031314
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Jack Bradford |
Corporate Director |
Jun 23, 2022 | |
| Healthtech Management Services Inc |
Operational/Managerial Control | Aug 18, 1992 | |
| Jody Daggett |
Corporate Director |
Jan 1, 2016 | |
| Edward Carpenter |
Corporate Director | Oct 24, 2006 | |
| Nick Renon |
Corporate Director | Jul 28, 2025 | |
| Paula Horn |
Corporate Director |
Feb 22, 2024 | |
| Neal Duane Jensen |
Corporate Officer |
Jul 10, 1998 | |
| Alan Osumi |
Corporate Director |
Mar 1, 2015 | |
| Robert E Hollis |
Corporate Director |
Jul 20, 2014 | |
| Jendean G Sartain |
Corporate Director | Mar 1, 2005 | |
| Frank Stapleton |
W-2 Managing Employee |
Jan 25, 2002 | |
| Fernando Shipley |
Corporate Director | Aug 1, 2004 | |
| Judy Bessee |
Corporate Director |
Feb 10, 2017 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Pleasant Valley Community Medical Center |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Jul 10, 1998 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Cobre Valley Community Hospital
Locations
5990 S Hospital Dr
Bldg D
Globe, AZ 85501
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
- Cobre Valley Tonto Basin Clinic
Other providers in Tonto Basin, AZ
All providers in Tonto Basin, AZ · Rural Health Clinic/Center 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 8, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.