NPIMap

Organization Active NPI

Maricopa County Special Health Care District

Doing business as Valleywise Health

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
National Provider Identifier
1164840302
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Doing business as
Valleywise Health
Practice address
2525 E Roosevelt St
Phoenix, AZ 85008-4948
Phone
(602) 344-8180
Fax
(602) 344-8122
NPI assigned
Apr 4, 2014
Last updated
Apr 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Authorized official

Name
Mrs. Kathleen Kirkland
Title
PFS Director
Phone
(602) 344-8178

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
General Acute Care Hospital 282N00000X H3673 AZ

Addresses

Primary practice location

2525 E Roosevelt St
Phoenix, AZ 85008-4948

Mailing address

PO Box 29670
Phoenix, AZ 85038-9670
Phone (602) 344-8180

Other identifiers 1

IdentifierTypeStateIssuer
946518MedicaidAZ

Other names 1

  • Valleywise Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251124003898 AZ Part A Provider - Federally Qualified Health Center (FQHC) 4688583651 Practice locations: Phoenix, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164840302. Details of each certification follow.

Federally qualified health center certification: CCN 031072

Legal name
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Doing business as
VALLEYWISE COMPREHENSIVE HEALTH CENTER - PHOENIX
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 25, 2025
Last certification
Oct 25, 2025
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
2525 E Roosevelt St
Suite 1a, 1B, 2B, 2D, 2E
Phoenix, AZ 85008-4948

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

National Provider Directory

National Provider Directory
Tax ID family
Maricopa County Special Health Care District23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Martin Demos Individual Corporate DirectorDirector Dec 2, 2024
Virginia Korte Individual Corporate DirectorDirector Dec 2, 2024
Barbara Mundell Individual Corporate DirectorDirector Feb 11, 2025
Maricopa County Special Health Care District Organization, Phoenix, AZ Medical provider/supplier Operational/Managerial Control Jan 1, 2005 100%
Earl Wilcox Individual Corporate DirectorDirector Dec 2, 2024
Claire Frieda Agnew Individual Corporate OfficerExecutive VP & Cfo Aug 1, 2020
W-2 Managing EmployeeExecutive VP & Cfo Jul 23, 2018
Pamela Fowler Individual Corporate DirectorSystem Director of Reimbursement Jul 23, 2018
W-2 Managing EmployeeSystem Director of Reimbursement Jul 23, 2018
Stephen Purves Individual Corporate OfficerPresident & Ceo Apr 24, 2014
W-2 Managing EmployeePresident & Ceo Apr 24, 2014

Owners & managing parties with NPI records 13

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

View all 13

All facility ownership & control disclosures 12

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

FacilityTypeRoleSince
Valleywise HealthPhoenix, AZ, CCN 03S022 Hospital Operational/Managerial Control Jan 1, 2005
Valleywise HealthPhoenix, AZ, CCN 030022 Hospital Operational/Managerial Control (100%) Jan 1, 2005
Valleywise Comprehensive Health Center - PeoriaPeoria, AZ, CCN 031073 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2005
Valleywise Community Health Center - McDowellPhoenix, AZ, CCN 031065 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2005
Valleywise Health Community Health Center - GuadalupeGuadalupe, AZ, CCN 031066 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2005
Valleywise Community Health Center - North PhoenixPhoenix, AZ, CCN 031067 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2005
Valleywise Community Health Center - West MaryvalePhoenix, AZ, CCN 031075 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2005
Valleywise Community Health Center - South Phoenix LaveenPhoenix, AZ, CCN 031071 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2005
Valleywise Community Health Center - ChandlerChandler, AZ, CCN 031082 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2005
Valleywise Community Health Center - AvondaleAvondale, AZ, CCN 031080 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2005
Valleywise Community Health Center - MesaMesa, AZ, CCN 031074 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2005
Valleywise Community Health Center - South CentralPhoenix, AZ, CCN 031083 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2005

Owned or controlled facilities with NPI records 17

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

View all 17

Facilities with the same owner 11

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

NPI Registry JSON

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

{
    "created_epoch": "1396569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1164840302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29670",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850389670",
            "telephone_number": "602-344-8180",
            "fax_number": "602-344-8122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 E ROOSEVELT ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850084948",
            "telephone_number": "602-344-8180",
            "fax_number": "602-344-8122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-04",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A",
        "authorized_official_last_name": "KIRKLAND",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "PFS  DIRECTOR",
        "authorized_official_telephone_number": "602-344-8178",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "AZ",
            "license": "H3673",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "946518",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valleywise Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.