NPIMap

Organization Active NPI

Chiricahua Community Health Centers, Inc

Doing business as Sierra Vista Behavioral Health Center

  • Federally Qualified Health Center (FQHC)
  • Sierra Vista, AZ
National Provider Identifier
1205547288
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHIRICAHUA COMMUNITY HEALTH CENTERS, INC
Doing business as
Sierra Vista Behavioral Health Center
Practice address
77 Calle Portal Ste C240
Sierra Vista, AZ 85635-2986
Phone
(520) 515-8669
NPI assigned
Dec 9, 2022
Last updated
Dec 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

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

Authorized official

Name
Daniel Abram Driscoll, MD
Title
Authorized Official
Phone
(520) 459-3011

Specialties & licenses 1

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

Addresses

Primary practice location

77 Calle Portal Ste C240
Sierra Vista, AZ 85635-2986

Mailing address

1100 N F Ave
Douglas, AZ 85607-1919
Phone (520) 459-3012

Other names 1

  • Sierra Vista Behavioral Health Center Doing business as

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
O20230323002549 AZ Part A Provider - Federally Qualified Health Center (FQHC) 5395638878 Practice locations: Sierra Vista, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205547288. Details of each certification follow.

Federally qualified health center certification: CCN 031023

Legal name
CHIRICAHUA COMMUNITY HEALTH CENTERS INC
Doing business as
BEHAVIORAL HEALTH CENTER - SIERRA VISTA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 13, 2023
Last certification
Mar 13, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 2022 in AZ
Enrollment address
77 Calle Portal
Ste C240
Sierra Vista, AZ 85635-2986

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
Daniel a Driscoll Individual Corporate OfficerCmo Jan 1, 2023
W-2 Managing EmployeeCmo Jan 1, 2023
Alvaro Montoya Individual Corporate DirectorBoard Treasurer Mar 27, 2017
Britt Hanson Individual Corporate DirectorBoard President Aug 20, 2022
Jonathan P Melk Individual Corporate OfficerCeo Nov 15, 2017
W-2 Managing EmployeeCeo Nov 15, 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 8, 2018
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 2

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

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1670544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670544000000",
    "number": "1205547288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 N F AVE",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "856071919",
            "telephone_number": "520-459-3012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 CALLE PORTAL STE C240",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352986",
            "telephone_number": "520-515-8669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIRICAHUA COMMUNITY HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-09",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-07",
        "status": "A",
        "authorized_official_last_name": "DRISCOLL",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "ABRAM",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "520-459-3011",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sierra Vista Behavioral Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sierra Vista, AZ

Sources for this page

Verify at the official NPI Registry.