NPIMap

Cobre Valley Regional Medical Center

Organization Active NPI Rural Health Clinic/Center · Globe, AZ

NPI 1245899384 · NPPES record last updated Jul 20, 2020

Key facts

NPI
1245899384
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
COBRE VALLEY REGIONAL MEDICAL CENTER
Practice address
5990 S Hospital Dr
Globe, AZ 85501-9462
Phone
(928) 425-8151
Fax
(928) 425-9425
NPI assigned
Jun 12, 2019
Organization subpart
Yes
Parent organization (as reported)
COBRE VALLEY REGIONAL MEDICAL CENTER

Authorized official

Name
Neal D Jensen
Title
Ceo
Phone
(928) 402-1122

Owners & managing parties with NPI records 2

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

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 9

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

Other NPIs with the same Medicare PAC ID 8

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

Corporate family (same tax ID) 12

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

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

Facilities with the same owner 7

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

Practitioners 41

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

View all 41

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in AZ

Rural health clinic certification: CCN 038514

Legal name
COBRE VALLEY REGIONAL MEDICAL CENTER
Doing business as
COBRE VALLEY RED ROCK CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 25, 2020
Last certification
Mar 14, 2023
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Mar 29, 1988 in AZ
Enrollment address
5990 S Hospital Dr
Globe, AZ 85501-9462
Related CCNs
031314

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
Jack Bradford
Individual 		Corporate Director
Vice Chairman		 Jun 23, 2022
Healthtech Management Services Inc
Organization · Franklin, TN
Corporation, Management services company 		Operational/Managerial Control Aug 18, 1992
Jody Daggett
Individual 		Corporate Director
Chief of Medical Staff		 Jan 1, 2016
Edward Carpenter
Individual 		Corporate Director
Trustee		 Oct 24, 2006
Nick Renon
Individual 		Corporate Director Jul 28, 2025
Paula Horn
Individual 		Corporate Director
Secretary		 Feb 22, 2024
Neal Duane Jensen
Individual 		Corporate Officer
Ceo		 Jul 10, 1998
Alan Osumi
Individual 		Corporate Director
Trustee		 Mar 1, 2015
Robert E Hollis
Individual 		Corporate Director
Treasurer		 Jul 20, 2014
Jendean G Sartain
Individual 		Corporate Director Mar 1, 2005
Frank Stapleton
Individual 		W-2 Managing Employee
Chief Clinical Operations Officer		 Jan 25, 2002
Fernando Shipley
Individual 		Corporate Director Aug 1, 2004
Judy Bessee
Individual 		Corporate Director
Chairman		 Feb 10, 2017

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Pleasant Valley Community Medical Center
Young, AZ · CCN 038500		 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 10, 1998

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040312001228 AZ Part B Supplier - Clinic/Group Practice 0648181693 Receives reassigned benefits from 69 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Young, AZ; Tonto Basin, AZ; Kearny, AZ; Globe, AZ; Superior, AZ
O20190807002988 AZ Part a Provider - Rural Health Clinic 0648181693 Practice locations: Globe, AZ

National Provider Directory

Tax ID family
Cobre Valley Community Hospital (13 organizations share this tax ID)
Part of
Cobre Valley Community Hospital

Locations

5994 S Hospital Dr
Globe, AZ 85501
Phone (928) 425-7108

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

5990 S Hospital Dr
Globe, AZ 85501-9462

Mailing address

5990 S Hospital Dr
Globe, AZ 85501-9462
Phone (928) 425-8151

Other names

  • Cobre Valley Red Rock Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 20, 2020.

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595203200000",
    "number": "1245899384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5990 S HOSPITAL DR",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855019462",
            "telephone_number": "928-425-8151",
            "fax_number": "928-425-9425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5990 S HOSPITAL DR",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855019462",
            "telephone_number": "928-425-8151",
            "fax_number": "928-425-9425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBRE VALLEY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COBRE VALLEY REGIONAL MEDICAL CENTER",
        "enumeration_date": "2019-06-12",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "NEAL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-402-1122"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cobre Valley Red Rock Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cobre Valley Red Rock Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Globe, AZ

All providers in Globe, AZ · Rural Health Clinic/Center in Arizona

Sources for this page

Verify at the official NPI Registry.