NPIMap

Organization Active NPI

Marana Health Center Inc

Doing business as Marana Health Center

  • Federally Qualified Health Center (FQHC)
  • Marana, AZ
National Provider Identifier
1164526471
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OTC-0032 Issued in AZ
Legal business name
MARANA HEALTH CENTER INC
Doing business as
Marana Health Center
Practice address
13395 N Marana Main St
Marana, AZ 85653-7008
Phone
(520) 682-4111
Fax
(520) 682-3817
NPI assigned
Sep 8, 2006
Last updated
May 6, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MARANA HEALTH CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 6, 2024

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

Authorized official

Name
Joshua B Carzoli, PHARMD
Title
Ceo
Phone
(520) 682-4111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X OTC-0032 AZ Primary

Addresses

Primary practice location

13395 N Marana Main St
Marana, AZ 85653-7008

Mailing address

PO Box 188
Marana, AZ 85653-0188
Phone (520) 682-4111

Other names 1

  • Marana Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031211000790 AZ Part B Supplier - Clinic/Group Practice 2365348091 Receives reassigned benefits from 165 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tucson, AZ; Oro Valley, AZ; Marana, AZ
O20100720000610 AZ Part A Provider - Federally Qualified Health Center (FQHC) 2365348091 1 other NPI on this enrollment
Practice locations: Marana, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164526471. Details of each certification follow.

Federally qualified health center certification: CCN 031837

Legal name
MARANA HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 12, 2002
Last certification
Nov 12, 2002
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 1, 1964 in AZ
Enrollment address
13395 N Marana Main St
Marana, AZ 85653-7008

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Marana Health Clinic42 organizations share this tax ID, including this one
Part of
Marana Health Clinic

Other organizations with this tax ID 41

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

View all 41

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Edward Sicurello Individual Corporate DirectorOfficer - Vice President Jul 10, 2023
John Decker Individual Corporate DirectorOfficer - President Apr 1, 2017
Celina Stude Individual Corporate DirectorOfficer - Secretary Jun 7, 2021
Joshua Carzoli Individual Corporate Officer100 Jan 26, 2023 90%
Operational/Managerial ControlCeo Jan 26, 2023 100%
Nathan Bolt Individual Corporate DirectorOfficer - Treasurer Sep 18, 2022
Anne Schmotzer Individual Corporate DirectorBoard Member Jan 19, 2023
Charles Steven Sera Individual Corporate DirectorDirector - Board Member Jul 22, 2013
Heidi Kurgat Individual Operational/Managerial ControlDirector of Compliance and Risk Mar 26, 2024
Janice L Truitt Individual Corporate DirectorDirector - Board Member Oct 23, 2017
Tanisha Quenette Green Individual Corporate DirectorDirector - Board Member Apr 3, 2023
Craig Reck Individual Corporate DirectorBoard Member Feb 1, 2021
Charles Feller Lang Individual Corporate DirectorDirector - Board Member Jul 1, 2024

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1164526471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "city": "MARANA",
            "state": "AZ",
            "postal_code": "856530188",
            "telephone_number": "520-682-4111",
            "fax_number": "520-682-3817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13395 N MARANA MAIN ST",
            "city": "MARANA",
            "state": "AZ",
            "postal_code": "856537008",
            "telephone_number": "520-682-4111",
            "fax_number": "520-682-3817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARANA HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARANA HEALTH CENTER INC",
        "enumeration_date": "2006-09-08",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A",
        "authorized_official_last_name": "CARZOLI",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-682-4111",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OTC-0032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marana Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marana, AZ

Sources for this page

Verify at the official NPI Registry.