NPIMap

Organization Active NPI

Gila Valley Clinic, PC

  • Family Medicine Physician
  • Safford, AZ
National Provider Identifier
1255510228
Registry record updated Sep 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GILA VALLEY CLINIC, PC
Practice address
1680 S 20TH Ave
Safford, AZ 85546-4011
Phone
(928) 428-1377
Fax
(928) 348-8570
NPI assigned
Oct 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2011

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

Authorized official

Name
Susan Jones, M.D.NPI 1114945201
Title
Owner
Phone
(928) 428-1377

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1680 S 20TH Ave
Safford, AZ 85546-4011

Mailing address

1680 S 20TH Ave
Safford, AZ 85546-4011
Phone (928) 428-1377

Other identifiers 1

IdentifierTypeStateIssuer
121963MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040624001267 AZ Part B Supplier - Clinic/Group Practice 4981680683 Receives reassigned benefits from 14 practitioners
Practice locations: Safford, AZ

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316476800000",
    "number": "1255510228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1680 S 20TH AVE",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855464011",
            "telephone_number": "928-428-1377",
            "fax_number": "928-348-8570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 S 20TH AVE",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855464011",
            "telephone_number": "928-428-1377",
            "fax_number": "928-348-8570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILA VALLEY CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-26",
        "last_updated": "2011-09-20",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-428-1377",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121963",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Safford, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; 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.