Kingman Healthcare, Inc

Primary specialty

Rehabilitation Hospital UnitTaxonomy code 273Y00000X

Legal business name

KINGMAN HEALTHCARE, INC

Practice address

3801 Santa Rosa Dr
Kingman, AZ 86401-2311

Phone

(928) 263-5688

Fax

(928) 263-5686

NPI assigned

Feb 8, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Tim Blanchard

Title

Cfo

Phone

(928) 681-8668

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• Kingman Regional Medical Center - Hualapai Mountain Campus Doing business as
• Kingman Hospital, Inc Former legal business name

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Hospital certification: CCN 03T055

Legal name

KINGMAN HEALTHCARE INC

Doing business as

KINGMAN REGIONAL MEDICAL CENTER

Organization structure

CorporationNon-profit

Incorporated

Sep 15, 1980 in AZ

Enrollment address

3801 Santa Rosa Dr
Kingman, AZ 86401-2311
Hospital Rehabilitation Unit

Hospital subgroups

Rehabilitation unit

Related certifications (CCN) 1

Facilities connected through Provider of Services related, parent or unit certification numbers.

• Kingman Healthcare, Inc

  • General Acute Care Hospital
  • Kingman, AZ
  • NPI 1265423917

  Unit of hospital

  Provider of Services

Other NPIs on the same Medicare enrollment 1

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

• Kingman Healthcare, Inc

  • General Acute Care Hospital
  • Kingman, AZ
  • NPI 1265423917

  O20120427000631

  Same enrollment

Listed as

Kingman Regional Medical CenterCCN 03T055

Ownership

Government

Certified

Jul 1, 2002

Tax ID family

Kingman Reg Med Ctr5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

• Kingman Healthcare, Inc

  • Home Health Agency
  • Kingman, AZ
  • NPI 1174701478
  NPD tax ID
• Kingman Healthcare, Inc

  • Community Based Hospice Care Agency
  • Kingman, AZ
  • NPI 1538347836
  NPD tax ID
• Kingman Healthcare, Inc

  • Urgent Care Clinic/Center
  • Kingman, AZ
  • NPI 1760703805
  NPD tax ID
• Kingman Healthcare, Inc

  • Community/Retail Pharmacy
  • Kingman, AZ
  • NPI 1992286298
  NPD tax ID

All disclosed owners & managing parties 14

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

Owners & managing parties with NPI records 3

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

• Brent J Bedke, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Kingman, AZ
  • NPI 1417186305

  Corporate Director

  CMS ownership
• Kale D Bodily, MD

  • Diagnostic Radiology Physician
  • Kingman, AZ
  • NPI 1174531933

  Corporate Director

  CMS ownership
• Ryan E Swapp, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Kingman, AZ
  • NPI 1962630863

  Corporate Director

  CMS ownership

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

{
    "created_epoch": "1202428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593648000000",
    "number": "1184802480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3269 STOCKTON HILL RD",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093619",
            "telephone_number": "928-757-0626",
            "fax_number": "928-692-2706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 SANTA ROSA DR",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864012311",
            "telephone_number": "928-263-5688",
            "fax_number": "928-263-5686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3269 N Stockton Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Kingman",
            "state": "AZ",
            "postal_code": "864093619",
            "country_code": "US",
            "telephone_number": "928-757-0626",
            "fax_number": "928-692-2706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KINGMAN HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-08",
        "last_updated": "2020-07-02",
        "certification_date": "2020-07-02",
        "status": "A",
        "authorized_official_last_name": "BLANCHARD",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "928-681-8668",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "AZ",
            "license": "SH5739",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "P0913870",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kingman Regional Medical Center - Hualapai Mountain Campus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kingman Hospital, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kingman Family Dental Group LLC
• Kingman Family Dentistry
• Kingman Family Practice, P.C.
• Kingman General Surgery PC
• Kingman Healthcare, Inc
• Kingman Healthcare, Inc
• Kingman Healthcare, Inc
• Kingman Healthcare, Inc
• Kingman Healthcare, Inc
• Kingman Healthcare, Inc

• Rehabilitation Hospital Unit in Kingman, AZ
• Providers in Kingman, AZ by specialty
• Rehabilitation Hospital Unit in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.