NPIMap

Organization Active NPI

DHHS IHS Phoenix

Doing business as Supai Health Center

  • Clinic/Center
  • Supai, AZ
National Provider Identifier
1184901829
Registry record updated Dec 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
DHHS IHS PHOENIX
Doing business as
Supai Health Center
Practice address
1 Main St
Supai, AZ 86435-0129
Phone
(928) 448-2641
NPI assigned
Nov 9, 2011
Last updated
Dec 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2022

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

Authorized official

Name
Lisa R Chamberlain
Title
Patient Business Office
Phone
(928) 769-2918

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1 Main St
Supai, AZ 86435-0129

Mailing address

PO Box 129
Supai, AZ 86435-0129
Phone (928) 448-2641

Other names 1

  • Supai Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120109000961 TX Part B Supplier - Clinic/Group Practice 7810163011 Receives reassigned benefits from 203 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Peach Springs, AZ; Supai, AZ

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Peach Springs Health Center5 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.

Practitioners & affiliated clinicians

Practitioners 194

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 194

NPI Registry JSON

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

{
    "created_epoch": "1320796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670803200000",
    "number": "1184901829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 129",
            "city": "SUPAI",
            "state": "AZ",
            "postal_code": "864350129",
            "telephone_number": "928-448-2641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MAIN ST",
            "city": "SUPAI",
            "state": "AZ",
            "postal_code": "864350129",
            "telephone_number": "928-448-2641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DHHS IHS PHOENIX",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-09",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A",
        "authorized_official_last_name": "CHAMBERLAIN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PATIENT BUSINESS OFFICE",
        "authorized_official_telephone_number": "928-769-2918"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Supai Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Supai Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Supai, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; 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.