NPIMap

Organization Active NPI

Chiricahua Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Douglas, AZ
National Provider Identifier
1174820898
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OTC5111 Issued in AZ
Legal business name
CHIRICAHUA COMMUNITY HEALTH CENTERS, INC
Practice address
815 15TH Street
Douglas, AZ 85607
Phone
(520) 364-5437
Fax
(520) 364-4261
NPI assigned
Feb 15, 2011
Last updated
Sep 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Authorized official

Name
Jonathan P Melk, MDNPI 1568496164
Title
Ceo
Phone
(520) 364-1429

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X OTC5111 AZ Primary

Addresses

Primary practice location

815 15TH Street
Douglas, AZ 85607

Mailing address

1205 F. Avenue
Douglas, AZ 85607
Phone (520) 364-1429

Other identifiers 1

IdentifierTypeStateIssuer
945141MedicaidAZ

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040206000860 AZ Part B Supplier - Clinic/Group Practice 5395638878 Receives reassigned benefits from 59 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bisbee, AZ; Willcox, AZ; Sierra Vista, AZ; Douglas, AZ; Elfrida, AZ; Benson, AZ
O20171129003270 AZ Part A Provider - Federally Qualified Health Center (FQHC) 5395638878 Practice locations: Douglas, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174820898. Details of each certification follow.

Federally qualified health center certification: CCN 031967

Legal name
CHIRICAHUA COMMUNITY HEALTH CENTERS INC
Doing business as
CHIRICAHUA COMMUNITY HEALTH CENTERS, INC - PEDIATRIC CENTER OF EXCELLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 20, 2017
Last certification
Nov 20, 2017
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Dec 6, 1995 in AZ
Enrollment address
815 E 15TH St
Douglas, AZ 85607-1631

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Chiricahua Community Health Centers Inc22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

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
Demetry Simonton Individual Corporate DirectorBoard Member Jan 11, 2025
Alvaro Montoya Individual Corporate DirectorBoard Treasurer Jun 25, 2019
Britt Hanson Individual Corporate DirectorBoard President Aug 20, 2022
Jonathan P Melk Individual Corporate OfficerCeo Oct 20, 2017
W-2 Managing EmployeeCeo Oct 20, 2017
Gary M McPherran Individual Corporate OfficerDirector of Finance Oct 20, 2017
W-2 Managing EmployeeDirector of Finance Oct 20, 2017
George Cullinan Individual Corporate DirectorBoard Member Mar 28, 2016
Amy Haritatos Individual Corporate DirectorBoard Member Oct 17, 2022
Tamra Venice Springer Individual Corporate Officer Jan 9, 2023
Corporate Director Jan 9, 2023
W-2 Managing Employee Jan 9, 2023
Carrie Gustavson Individual Corporate DirectorBoard Vice President Oct 20, 2017
Karl Griffor Individual Corporate DirectorBoard Secretary Dec 3, 2024
Alma Vildosola Individual Corporate DirectorBoard Member Nov 28, 2016
Caleb Blaschke Individual Corporate DirectorBoard Member Jan 11, 2025
Lawerence Sanders Individual Corporate DirectorBoard Member Jan 11, 2025

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1297728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630454400000",
    "number": "1174820898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 F. AVENUE",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "85607",
            "telephone_number": "520-364-1429",
            "fax_number": "520-364-4261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 15TH STREET",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "85607",
            "telephone_number": "520-364-5437",
            "fax_number": "520-364-4261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIRICAHUA COMMUNITY HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-15",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A",
        "authorized_official_last_name": "MELK",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-364-1429",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OTC5111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "945141",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglas, AZ

Sources for this page

Verify at the official NPI Registry.