NPIMap

Organization Active NPI

Community Bridges, Inc.

  • Community/Behavioral Health Agency
  • Yuma, AZ
National Provider Identifier
1174863252
Registry record updated Feb 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
OTC6002 Issued in AZ
Legal business name
COMMUNITY BRIDGES, INC.
Practice address
3250 E 40TH St Ste C
Yuma, AZ 85365-7994
Phone
(928) 341-4220
Fax
(928) 344-4457
NPI assigned
Feb 26, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2023

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

Authorized official

Name
John Hogeboom, LISAC
Title
President/Ceo
Phone
(480) 831-7566

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X BH-4045 AZ
Nursing Care Agency 251J00000X OTC6002 AZ
Community/Behavioral Health Agency 251S00000X OTC6002 AZ Primary
Clinic/Center 261Q00000X
Health Service Clinic/Center 261QH0100X OTC6002 AZ
Adult Mental Health Clinic/Center 261QM0850X OTC6002 AZ
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X OTC6002 AZ
Clinical Medical Laboratory 291U00000X OTC6002 AZ
Non-emergency Medical Transport (VAN) 343900000X OTC6002 AZ

Addresses

Primary practice location

3250 E 40TH St Ste C
Yuma, AZ 85365-7994

Mailing address

1855 W Baseline Rd
Suite 101
Mesa, AZ 85202-9000
Phone (480) 831-7566

Other identifiers 1

IdentifierTypeStateIssuer
206501MedicaidAZ

Other names 1

  • Yuma Outpatient Services Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110606000388 AZ Part B Supplier - Clinic/Group Practice 2062699721 Receives reassigned benefits from 126 practitioners
36 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tucson, AZ; Phoenix, AZ; Payson, AZ; Winslow, AZ; Yuma, AZ; Mesa, AZ; Page, AZ; Avondale, AZ…

Other NPIs on the same Medicare enrollment 28

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

View all 28

National Provider Directory

National Provider Directory

Locations

3250 E 40th St
Ste C
Yuma, AZ 85365
Phone (928) 341-4220

NPI Registry JSON

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

{
    "created_epoch": "1361836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676332800000",
    "number": "1174863252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 W BASELINE RD",
            "address_2": "SUITE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852029000",
            "telephone_number": "480-831-7566",
            "fax_number": "480-962-7671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 E 40TH ST STE C",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853657994",
            "telephone_number": "928-341-4220",
            "fax_number": "928-344-4457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY BRIDGES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-26",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A",
        "authorized_official_last_name": "HOGEBOOM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "480-831-7566",
        "authorized_official_credential": "LISAC"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "AZ",
            "license": "BH-4045",
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "AZ",
            "license": "OTC6002",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "OTC6002",
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "AZ",
            "license": "OTC6002",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "AZ",
            "license": "OTC6002",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "AZ",
            "license": "OTC6002",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "OTC6002",
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "AZ",
            "license": "OTC6002",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206501",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yuma Outpatient Services Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Yuma Outpatient Services Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yuma, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.