NPIMap

Organization Active NPI

La Paz Regional Hospital, Inc.

  • Clinic/Center
  • Bouse, AZ
National Provider Identifier
1235154147
Registry record updated Apr 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
LA PAZ REGIONAL HOSPITAL, INC.
Practice address
44031 E Plumosa Road
Bouse, AZ 85325
Phone
(928) 669-8512
Fax
(928) 851-1828
NPI assigned
Jul 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2026

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

Authorized official

Name
Guadalupe Michelle Baldenegro
Title
Medical Staff Coordinator
Phone
(928) 669-7382

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

44031 E Plumosa Road
Bouse, AZ 85325

Mailing address

1200 W Mohave Rd
Parker, AZ 85344-6349
Phone (928) 669-9201

Other identifiers 1

IdentifierTypeStateIssuer
CG7880OtherAZMEDICARE RR

Other names 1

  • Bouse Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031219000694 AZ Part B Supplier - Clinic/Group Practice 1557273356 Receives reassigned benefits from 94 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salome, AZ; Quartzsite, AZ; Parker, AZ; Bouse, AZ
O20080618000378 AZ Part A Provider - Rural Health Clinic 1557273356 Practice locations: Bouse, AZ

Rural health clinic certification: CCN 033999

Legal name
LA PAZ REGIONAL HOSPITAL INC
Doing business as
BOUSE MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 3, 2009
Last certification
Apr 7, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Feb 9, 1972 in AZ
Enrollment address
44031 E Plumosa Road
Bouse, AZ 85325-0866
Related CCNs
031317

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
Lapaz Internal Medicine9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Philip Cushman Individual Corporate Director Feb 1, 2015
Jerry Palmer Individual Corporate Director Sep 1, 2012
La Paz Regional Hospital Inc Organization, Parker, AZ Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 1990
Jack D Dunn Individual Corporate Director Oct 1, 2012
Patricia Brink Individual Corporate Director Jul 1, 2011
Donald Denton Individual Corporate DirectorVice-Chair Oct 1, 2014
Amanda Barrera Individual Corporate Director Oct 1, 2013
Yolanda Holt Individual W-2 Managing EmployeeBusiness Office Director Apr 1, 2000
Mary Victoria Clark Individual Corporate Officer May 20, 2002
Norman Simpson Individual Corporate DirectorChair Oct 1, 2013
Juanita F Phelps Individual Corporate DirectorSecretary Oct 1, 2011
Julian Barbara Individual Corporate Director Oct 1, 1990
Cheryl Montijo Individual Corporate Director Oct 1, 2000
Lily Click Individual Corporate Director Sep 1, 2014
Ronald D Parker Individual Corporate Director Oct 1, 2012
Ruth Cline Individual Corporate Director Sep 1, 2014

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
La Paz Regional Hospital IncParker, AZ, CCN 031317 Hospital Operational/Managerial Control (100%) Jan 1, 2017
La Paz Regional Hospital IncParker, AZ, CCN 03Z317 Hospital Operational/Managerial Control Jan 1, 2017
La Paz Medical Services-QuartzsiteQuartzsite, AZ, CCN 033987 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 7, 1994
Tri-Valley Medical CenterSalome, AZ, CCN 033994 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2006

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 58

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 58

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777248000000",
    "number": "1235154147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W MOHAVE RD",
            "city": "PARKER",
            "state": "AZ",
            "postal_code": "853446349",
            "telephone_number": "928-669-9201",
            "fax_number": "928-669-7417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44031 E PLUMOSA ROAD",
            "city": "BOUSE",
            "state": "AZ",
            "postal_code": "85325",
            "telephone_number": "928-669-8512",
            "fax_number": "928-851-1828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA PAZ REGIONAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A",
        "authorized_official_last_name": "BALDENEGRO",
        "authorized_official_first_name": "GUADALUPE",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "MEDICAL STAFF COORDINATOR",
        "authorized_official_telephone_number": "928-669-7382"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "CG7880",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bouse Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bouse, AZ

Sources for this page

Verify at the official NPI Registry.